After a long and bitter national debate, a new kind of waiting list for liver transplants is expected to go into effect next year.

        Cincinnati experts say it probably won't affect the number of liver transplants performed locally, but some predict that more patients will have to wait until they are sicker before they get a transplant.

        On Nov. 16, the United Network for Organ Sharing (UNOS) voted to adopt new criteria for allocating donated livers to patients. The system is called the Mayo End-Stage Liver Disease Model (MELD).

        While defenders of the existing organ-sharing system say the change is a large concession, critics say it still doesn't go far enough to end sometimes wide disparities in waiting times among patients in different parts of the country.

        “What this does is eliminate waiting times except as a tie-breaker,” said Dr. Douglas Hanto, director of the adult liver transplant program at University Hospital. “People are ranked in the queue based on the severity of their disease.”

        Under the current system, a donated organ is first offered to the sickest local patient that has a tissue match, then to regional patients, then to other regions. That means a local or regional patient can get an organ even if there's a sicker patient elsewhere in the country.

        Greater Cincinnati, where 35 to 40 adult liver transplants are performed a year, is part of a region that includes the rest of Ohio, Indiana and Michigan.

        The MELD model creates a points system based on how patients fare on tests of liver function, kidney function and blood-clotting ability, all of which reflect the severity of liver disease. The more points, the sicker the patient.

        Under the current system, about 10 percent of the adult patients who get transplants here are considered in the most acute need, now called Status 1. About 20 percent are considered Status 2A and the rest are Status 2B.

        The status categories depend partly on what type of liver disease they have, acute versus chronic; as well as predictions over how long the patient might live without a transplant; and how long a patient has been on the waiting list.

        These categories would be replaced by the point system. The more objective results will mean less dispute over who is really the sickest patient, Dr. Hanto said.

        However, the Campaign for Transplant Fairness, a lobbying group in Washington, D.C., says the MELD system doesn't go far enough. It won't eliminate the regional organ-sharing boundaries, which means a not-as-sick patient in one state could still get a transplant before a sicker patient just across the border.

        “There is plenty of evidence that the current system of organ allocation is not fair and that patients are needlessly dying because they are being overlooked in favor of healthier patients,” said Craig Irwin, president of the National Transplant Action Committee.

        Dr. Hanto, who sits on a UNOS committee that recommended the MELD system, said the idea of a single national waiting list for livers is dead. Instead, there has been much discussion, but no agreement yet, on re-drawing some regional boundaries.

        The region including Cincinnati includes about 25 million people, which many at UNOS consider about the ideal size, Dr. Hanto said. UNOS members felt that it would be best to see how well the MELD system works before trying to re-draw organ allocation regions, he said.

        The regional boundary problems are most severe in New York, California and Texas. Dr. Hanto said none of the border changes proposed so far would change the region including Greater Cincinnati.

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