{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T05:45:35Z","timestamp":1761630335226,"version":"3.33.0"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":5297,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2001,3]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Liver allocation remains problematic because current policy prioritizes status 2B or 3 patients by waiting time rather than medical urgency. On February 21, 2000, we implemented a variance to the United Network for Organ Sharing liver allocation policy that redefined status 2A by much more rigid, definable criteria and prioritized status 2B patients by using a continuous medical urgency score based on the Child-Turcotte-Pugh score and other medical conditions. In this system, waiting time is used only to differentiate status 2B candidates with equal medical urgency scores. Comparing the 6-month period (period 1; n = 67) before implementation of this system to the 6-month period after implementation (period 2; n = 75), there was a significant reduction in the number of transplantations performed for patients listed as status 2A (46.3% to 14.7%; <jats:italic toggle=\"yes\">P<\/jats:italic> = .002) and an increase in the number of patients listed as status 2B who received transplants (44.8% to 70.7%; <jats:italic toggle=\"yes\">P<\/jats:italic> = .10). Most dramatically, there was a 37.1% reduction in overall deaths on the waiting list from 94 deaths in period 1 to 62 deaths in period 2 (<jats:italic toggle=\"yes\">P<\/jats:italic> = .005), with the most significant reduction for patients removed from this list at status 2B (52 <jats:italic toggle=\"yes\">v<\/jats:italic> 18 patients; <jats:italic toggle=\"yes\">P<\/jats:italic> = .04). There were 3 postoperative deaths in each period, with only 1 graft lost in period 2. Status 2B patients with the greatest degree of medical urgency received transplants without multiple peer reviews requesting elevation to 2A status. We conclude that a continuous medical urgency score system allocates donor livers much more fairly to those in medical need and reduces waiting list mortality without sacrificing efficacy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1053\/jlts.2001.22180","type":"journal-article","created":{"date-parts":[[2004,3,19]],"date-time":"2004-03-19T18:49:45Z","timestamp":1079722185000},"page":"173-178","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":54,"title":["Preliminary results of a liver allocation plan using a continuous medical severity score that de-emphasizes waiting time"],"prefix":"10.1097","volume":"7","author":[{"given":"Richard B.","family":"Freeman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Rohrer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eliezer","family":"Katz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedict A.","family":"Cosimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Delmonico","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Lorber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"O\u2019Connor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Bradley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"10.1053\/jlts.2001.22180-BIB2","unstructured":"United Network for Organ Sharing. Policy 3.6, Allocation of livers. Available at: www.unos.org. Accessed: October 13, 2000."},{"key":"10.1053\/jlts.2001.22180-BIB3","first-page":"75","volume-title":"Organ Procurement and Transplantation. Assessing current policies and the potential impact of the DHHS final rule. Committee on Organ Procurement and Transplantation Policy, Division of Health Sciences Policy, Institute of Medicine","year":"1999","unstructured":"Organ Procurement and Transplantation. Assessing current policies and the potential impact of the DHHS final rule. Committee on Organ Procurement and Transplantation Policy, Division of Health Sciences Policy, Institute of Medicine. Washington, DC: National Academy Press, 1999:75."},{"key":"10.1053\/jlts.2001.22180-BIB4","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1053\/jlts.2000.9744","volume":"6","author":"Freeman","year":"2000","journal-title":"Liver Transpl"},{"key":"10.1053\/jlts.2001.22180-BIB5","unstructured":"United Network for Organ Sharing. Policy 3.6.4.4, Allocation of livers. Available at: www.unos.org. Accessed: October 13, 2000."},{"volume-title":"1999 Annual Report","key":"10.1053\/jlts.2001.22180-BIB6","unstructured":"New England Organ Bank. 1999 Annual Report. Newton, MA: New England Organ Bank (data on file)."},{"key":"10.1053\/jlts.2001.22180-BIB7","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/00007890-199401001-00033","volume":"57","author":"Muto","year":"1994","journal-title":"Transplantation"},{"key":"10.1053\/jlts.2001.22180-BIB8","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1001\/jama.281.15.1381","volume":"281","author":"Showstack","year":"1999","journal-title":"JAMA"},{"author":"Freeman","key":"10.1053\/jlts.2001.22180-BIB9","unstructured":"et al. Direct costs for one year of liver transplant care are directly associated with disease severity at transplant. Transplant Proc 2001 (in press)."}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1053%2Fjlts.2001.22180","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-200103000-00002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T15:01:46Z","timestamp":1737730906000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-200103000-00002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,3]]},"references-count":8,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2001]]}},"URL":"https:\/\/doi.org\/10.1053\/jlts.2001.22180","relation":{},"ISSN":["1527-6465"],"issn-type":[{"type":"print","value":"1527-6465"}],"subject":[],"published":{"date-parts":[[2001,3]]}}}