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According to a new study released Monday, children who need a liver transplant to save lives are losing adults.
A system used to determine who is most in need of a transplant significantly underestimates the risk of death in younger children with liver disease, the team found. University of Pittsburgh.
That means adults jump the line in front of children for rare transplants, the researchers said.
"Children with chronic liver disease who need a transplant can be at a disadvantage compared to adults in a similar situation," they wrote in their report, published in the journal JAMA Pediatrics.
"This study proves that children are not given enough priority to access transplantation," says Dr. Evelyn Hsu, a liver pediatrician at the University of Washington School of Medicine. next to her.
"The results demonstrate what almost all physicians taking care of children needing a liver transplant have suspected as early as 2005."
The need for all organs for transplantation is disastrous. According to the Federal Network of Organ Procurement and Transplantation, 114,507 people are waiting for an organ transplant. Only 24,213 received a transplant this year, from 11,622 donors.
The waiting list is long because few people register to become organ donors. Living donors can donate one kidney and sometimes a part of the other, but all other organs must come from deceased people. Families are often reluctant to release the organs of a loved one in time and under the circumstances necessary for them to be useful.
For this reason, there is a long list of people needing a transplant, and doctors need to know first who needs the organ the most and then who is most likely to survive after a transplant.
There are separate systems for adults and children requiring liver: pediatric terminal-stage liver disease and the model for end-stage liver disease. The unified network for organ sharing manages the system that associates organs with patients.
The team examined more than 4,000 children enrolled in liver transplants between 2002 and 2014, and continued in 2016. During this period, approximately 400 children died while waiting for a transplant.
They found that the pediatric rating system underestimated the likelihood of the child dying without a transplant.
"Using long-term national data, our report is the first to show that the scoring system alone significantly underestimates the risk of death in the next 90 days and therefore disadvantages children." of the Department of Health Policy of the School of Public Health of the University of Pittsburgh, said in a statement.
This is unfair and unacceptable to most people, said Hsu and his colleagues.
"About 500 deceased donor liver transplants are performed annually in children in the United States, a number that has remained constant over the past two decades, while the number of adults receiving transplants is more than ten times higher and increases by 10%. per year, "they wrote.
"Most of this increase can be attributed to adults over 65 years of age. In the context of a limited supply of livers for transplantation, the central question is who to prioritize for transplantation and how to do it. "
Children must almost always have organs from other children, while adults can receive organs from other adults and children.
"Eighty percent of children on the waiting list receive liver transplants from pediatric donors," wrote Hsu and his colleagues. "Paradoxically, although there are enough pediatric donor organs to meet the demand of children in need of a liver transplant, the current UNOS policy requires they are best allocated to adults at the local and regional level rather than to critically ill children at the national level.
Other countries usually give children priority for liver transplants, they noted, with good results.
The organ sharing network was not able to provide immediate feedback on the results.
But the organ allocation system is being re-evaluated. The Organs and Transplant Supply Network is making public comments on some of the proposals.
In 2013, parents of a child dying from cystic fibrosis complications went to court to sue in order to force providers to allow him to be put on the waiting list for the adult lungs and the lungs of other children. The Department of Health and Social Services refused to make an exception for the 11-year-old girl, but a court overruled that decision.
Sarah Murnaghan, now 16, received two lung transplants: the first failed, but the second kept her alive.
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