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Truth and Consequences: The Challenge of Greater Transparency in Liver Distribution and Utilization

The system for distribution of deceased donor liver allografts has undergone relatively minor modifications over the past 15 years. The local-regional-national algorithm has been modified with small changes for discrete patient groups that impact a minor percentage of the total liver transplant volume. The proliferation of transplant centers has contributed to an entrenchment of the local donation service area as the primary distribution unit, with an amplified level of competition between centers. This has resulted in the relatively infrequent occurrence where a liver is placed nationally with a center outside the region of origin of the donor.