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United States liver allocation.

PURPOSE OF REVIEW
The current review discusses the system of liver allocation in the United States, the adoption of the national liver review board (NLRB), and the pending major change to the system of distribution (acuity circle model).


RECENT FINDINGS
The system of liver allocation in the United States is based on the model for end-stage liver disease (MELD) score, a formula which uses commonly available tests (international normalized ratio, bilirubin, creatinine, and recently, sodium) prioritizes candidates on the waitlist according to likelihood of death without access to transplant. This review provides an overview of modifications to MELD allocation and well as a summary of the benefits and weaknesses. The review also details the pending major revision to the distribution of liver allografts, which attempts to reduce the geographic disparity in access by sharing across a broader geographic area. Finally, the review describes the implementation of the NLRB, which replaced the previous system in May 2019.


SUMMARY
The system of liver allocation and distribution in the United States has been subject to ongoing optimization, though the recent adoption of the NLRB, and pending change to distribution will significantly impact the system with the goal of reducing geographic disparity.