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Director's Comments Transcript: Liver Transplant Allocation Process & Challenges 01/05/2009

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Greetings from the National Library of Medicine and

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

To listen to Dr. Lindberg's comments, click herelisten

Some racially-based disparities for the estimated 16,000 Americans waiting to receive a liver transplant are improving, but gender differences persist, suggests a study recently published in the Journal of the American Medical Association.

Specifically, African American men are no longer as likely to die before receiving a liver transplant, or be too ill to receive a liver transplant, than white American men, the study found. However, women patients are more likely (than men) to die before receiving a liver transplant, are more likely to be too ill to obtain one, and are less likely to receive a new liver three years after they register.

Before 2002, 27 percent of African American compared to a little less than 22 percent of white patients died or became too sick to receive a transplant within three years after registering for a new liver. Black Americans also were less likely than whites to receive a new liver within three years of registration.

The authors of an editorial accompanying the study add the pre-2002 differences were perceived as examples of inequities in the U.S.' organ allocation system -- despite the fact that African Americans have a higher rate of liver disease than national averages.

Then, six years ago, the Model for End-Stage Liver Disease, or MELD, screening test was introduced. The MELD score is based on a combination of three widely available laboratory tests. It assesses organ dysfunction and determines when someone should receive a liver transplant based on the severity of his or her illness. The test predicts the risk that a person with liver disease will die in three months.

Before MELD, the determination was based on how long a patient waited to receive a liver transplant and some subjective physician judgments, the study's six authors, who are from Duke University Medical Center, explain.

However, in the six years since MELD was introduced, the Duke study found the disparities in allocating liver transplants narrowed among most men. About 26 percent of African Americans and 22 percent of whites now die or are too sick for a transplant within three years of registering for a liver. Moreover, blacks also are now just as likely to receive a new liver within three years of registering as white Americans.

The Duke study's findings are based on about 24,000 patients who registered with the U.S. Organ Procurement and Transplantation Network waiting list, which is a national registry. While the study's findings are not based on patient population sampling, the authors only compared black and white patients.

Despite some progress among men, the study also found women are more likely to die, or become took sick for liver transplant than men, and are less likely to receive a new liver within three years after registration.

Although the accompanying editorial applauds the use of the MELD test, plus national improvements among men, its authors ask why some gender disparities persist?

The editorial's two authors explain women require smaller livers for transplantation because they are often physically smaller than men. They add physically smaller transplant recipients often cannot safely receive a liver from physically larger persons because their larger livers do not fit or function as well. Unfortunately, this means adult women (unlike men) need to receive donated livers that also can be used for some teens and youngsters, who occasionally need transplants. So, the pool of appropriately sized livers is smaller for adult women.

Also, the authors explain there are women's health differences, (such as higher rates of autoimmune disease) that may lower MELD scores, which can falsely suggest a woman does not need a new liver. As a result, the authors suggest some adjustments to the MELD testing procedure that would rebalance the allocation of available livers.'s liver transplantation health topic page notes most liver transplants come from a donor who has died. A disease of the bile ducts often triggers the need for a new liver in children. In adults, a liver with cirrhosis, where healthy liver cells die and are replaced with scar tissue, remains the leading cause of transplants.'s liver transplantation health topic page also is comprehensive and begins with a JAMA patient page on liver transplantation and an overview website called 'What I need to know about liver transplantation' from the National Institute of Diabetes and Digestive and Kidney Diseases.

MedlinePlus' liver transplantation health topic page contains a section on treatment, and disease management. A link to a website with information about the MELD test (from the United Network for Organ Sharing) is provided in the 'related issues' section. In addition, the latest related news, information on liver transplant clinical trials, research results, directories of physician referrals, organizations, and liver transplant information for children are available. also contains separate health topic pages on: cirrhosis, hepatitis, liver disease, organ transplantation, the digestive system, plus transplantation and donation. All the latter are linked to liver transplant issues.

To find's liver transplant health topic page, type 'liver transplant' in the search box on's home page. Then, click on 'Liver transplantation (National Library of Medicine).'

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