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World J Hepatol. Aug 27, 2021; 13(8): 830-839
Published online Aug 27, 2021. doi: 10.4254/wjh.v13.i8.830
Evolution of liver transplant organ allocation policy: Current limitations and future directions
Alexander Polyak, Alexander Kuo, Vinay Sundaram
Alexander Polyak, Alexander Kuo, Vinay Sundaram, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Author contributions: Sundaram V performed the outline of manuscript and critical revision; Polyak A and Kuo A drafted the manuscript.
Conflict-of-interest statement: The authors report no conflicts of interest in relation to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vinay Sundaram, MD, MSc, Associate Professor, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States. vinay.sundaram@cshs.org
Received: January 28, 2021
Peer-review started: January 28, 2021
First decision: May 3, 2021
Revised: June 22, 2021
Accepted: July 22, 2021
Article in press: July 22, 2021
Published online: August 27, 2021
Core Tip

Core Tip: Since the adoption of the model for end-stage liver disease (MELD) score for organ allocation in 2002, there have been numerous changes to policy in an effort to make organ allocation and distribution more fair and equitable. This review highlights policy changes since the adoption of the MELD score, addresses limitations of the MELD score, reviews proposed alternatives to MELD, and examines the specific implications of these changes and alternatives for acute-on-chronic liver failure.