ArticleClinical transplantation2023
Removing geographic boundaries from liver allocation: A method for designing continuous distribution scores.
Article in Clinical transplantation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed.
- State-Level Geographic Disparities in Liver Transplant Access: Waitlist Outcome Patterns.Journal of clinical medicine · 2026Article
- Optimizing Liver Transplant Allocation for Hepatocellular Carcinoma: Development and Validation of a Survival Benefit-Based Model.Clinical transplantation · 2026Article
- The association of place-based disadvantage and access to deceased donor heart transplantation.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2026Article
- Liver Transplant Anesthesia Practice Patterns in Canada, Australia, and New Zealand: Results From a Multi-National Survey.Clinical transplantation · 2026Article
- Optimizing kidney allocation: challenges and solutions.Current opinion in organ transplantation · 2025Review
- Mitigating the Disparate Impacts of Longevity Matching of Kidney Transplants.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2024Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundThe Organ Procurement and Transplantation Network (OPTN) is eliminating geographic boundaries in liver allocation, in favor of continuous distribution. Continuous distribution allocates organs via a composite allocation score (CAS): a weighted sum of attributes like medical urgency, candidate biology, and placement efficiency. The opportunity this change represents, to include new variables and features for prioritizing candidates, will require lengthy and contentious discussions to establish community consensus. Continuous distribution could instead be implemented rapidly by computationally translating the allocation priorities for pediatric, status 1, and O/B blood type liver candidates that are presently implemented via geographic boundaries into points and weights in a CAS.
methodsUsing simulation with optimization, we designed a CAS that is minimally disruptive to existing prioritizations, and that eliminates geographic boundaries and minimizes waitlist deaths without harming vulnerable populations.
resultsCompared with Acuity Circles (AC) in a 3-year simulation, our optimized CAS decreased deaths from 7771.2 to 7678.8 while decreasing average (272.66 NM vs. 264.30 NM) and median (201.14 NM vs. 186.49 NM) travel distances. Our CAS increased travel only for high MELD and status 1 candidates (423.24 NM vs. 298.74 NM), and reduced travel for other candidates (198.98 NM vs. 250.09 NM); overall travel burden decreased.
conclusionOur CAS reduced waitlist deaths by sending livers for high-MELD and status 1 candidates farther, while keeping livers for lower MELD candidates nearby. This advanced computational method can be applied again after wider discussions of adding new priorities conclude; our method designs score weightings to achieve any specified feasible allocation outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.