Hope or efficacy in donor liver allocation?

Both the number of recipients awaiting liver transplantation and the length of wait are increasing, giving rise to increasing concern by patients, hea lthcare professionals, and the public. Greater attention has been focused o n the criteria for listing patients for transplantation and for allocation of organs. In the U.K., compared with the U.S., the delivery of liver trans plant services is more tightly regulated, with fewer transplant centers, lo wer transplant rates, shorter waiting lists, and shorter waiting times. The reasons for these differences are unclear. In the U.K., patients are liste d only if there is a reasonable expectation that the patient will receive a graft. The criteria for listing are based on overall utility rather than i ndividual benefit, so the criterion for listing is that the patient will ha ve at least a greater than 50% probability of being alive 5 years after tra nsplantation with quality of life that is acceptable to the patient. Althou gh it is reasonable to offer hope to all patients, this hope should have a reasonable probability of being fulfilled. Listing patients with little lik elihood of benefiting from transplantation is not helpful either for the pa tient, their family, or the other potential liver allograft, recipients. Wh ile different systems for allocation of donor livers may be more appropriat e in other settings, the process in the U.K. seems to del. er satisfactoril y.