The Liver Transplant Program at the Charité Berlin.
Pascher A, Neuhaus P.
Clinical Transplants 2010, Chapter 17
Liver transplantation is a well established procedure for patients in end-stage liver disease. The Liver Transplant Program at the Charit Berlin has 22 years of experience with over 2500 transplanted patients. Notwithstanding the progress in the field the overall outcome after liver transplantation has been challenged recently because of a rising demand for donor livers in the presence of a severe lack of suitable organs, rising numbers of extended criteria donors, and erroneous developments of allocation algorithms. In order to facilitate a just, transparent, and balanced allocation of a limited number of deceased donor livers, a MELD-based allocation system was imposed in the EUROTRANSPLANT-region in December 2006. Though waiting list mortality was successfully reduced from 20 to 10% since then, 1-year post-transplant patient outcome was impaired by a similar extent from 90% to below 80%. Concurrently, the allocation threshold rose significantly (Fig. 6); the mean match-MELD increased from 25 to 34 in Germany. Reasons for that are certainly multifactorial. However, inappropriate incentives on the basis of a rising economic pressure and a limitation of medical resources contribute significantly. In order to overcome these erroneous developments allocation algorithms and incentives should be modified.