A unos perspective on donor liver allocation

Issues in Donor liver Allocation n this, the inaugural publication of The Crucible, we examine the issue of donor liver allocation.I To that purpose, we have invited discussion from a panel of authors with wide-ranging perspectives on this issue.Randy Bollinger is a former President of the United Network for Organ Sharing (UNOS) and the Chief of General Surgery at Duke University.He provides both a brief history of UNOS and an explanation of the current policies used by UNOS for allocation of donor livers.Goran Klintmalm is the Director of Transplantation Services at Baylor University Medical Center in Dallas.His program in liver transplantation is one of seven programs in the country to have performed more than 100 liver transplantations in 1993.His perspective is that of the director of a large program with a continually expanding waiting list in the face of increasing competition for donor organs.William Payne is the Director of the Liver Transplant Program at the University of Minnesota.He provides a point of view shared by a large number of liver transplant surgeons who are striving to maintain high-quality smaller programs in the face of mounting economic and institutional pressures on resources.Roger Evans was for 8 years Senior Research Scientist of the Health and Population Research Center at Battelle Seattle Research Center before becoming Head of the Section of Health Services Evaluation at the Mayo Clinic.Dr Evans has written extensively on a variety of issues related to the economics of transplantation.His contribution to our discussion provides evidence that our traditional thinking about selection of transplant candidates, and thus, in effect, our allocation of donor organs, is likely to face much greater challenges in the new era of contracted care and capitation.His portrayal of the new economics of health care should cause us all to consider what ethical conflicts our assumption of financial risks will impose.