Ethical considerations surrounding survival benefit-based liver allocation

Eric J. Keller, Paul Y. Kwo, Paul R. Helft

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations


The disparity between the demand for and supply of donor livers has continued to grow over the last 2 decades, and this has placed greater weight on the need for efficient and effective liver allocation. Although the use of extended criteria donors has shown great potential, it remains unregulated. A survival benefit-based model was recently proposed to answer calls to increase efficiency and reduce futile transplants. However, it was previously determined that the current allocation system was not in need of modification and that instead geographic disparities should be addressed. In contrast, we believe that there is a significant need to replace the current allocation system and complement efforts to improve donor liver distribution. We illustrate this need first by identifying major ethical concerns shaping liver allocation and then by using these concerns to identify strengths and shortcomings of the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease system and a survival benefit-based model. The latter model is a promising means of improving liver allocation: it incorporates a greater number of ethical principles, uses a sophisticated statistical model to increase efficiency and reduce waste, minimizes bias, and parallels developments in the allocation of other organs. However, it remains limited in its posttransplant predictive accuracy and may raise potential issues regarding informed consent. In addition, the proposed model fails to include quality-of-life concerns and prioritize younger patients. We feel that it is time to take the next steps toward better liver allocation not only through reductions in geographic disparities but also through the adoption of a model better equipped to balance the many ethical concerns shaping organ allocation. Thus, we support the development of a similar model with suggested amendments.

Original languageEnglish (US)
Pages (from-to)140-146
Number of pages7
JournalLiver Transplantation
Issue number2
StatePublished - Feb 2014

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Fingerprint Dive into the research topics of 'Ethical considerations surrounding survival benefit-based liver allocation'. Together they form a unique fingerprint.

Cite this