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Acuity circle allocation will likely have big impact on pediatric liver transplant disparities

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In February 2020, an acuity circle policy was implemented for liver organ distribution to reduce geographic variability to access of liver transplantation experienced with the previous donation service area (DSA) system.

At the 2021 SPLIT Annual Meeting, Doug Mogul MD, MPH John Hopkins University School of Medicine, discussed some of the projected outcomes of the new policy as it relates to pediatric liver transplantation.

 Dr Mogul explained that under the old system pediatric mortality and access were an issue.

Approximately 1 in 10 children under the age of 2 years and 1 in 20 children between the ages of 2-17 years will die on the pediatric waitlist, Dr Mogul said.

More so, 45% of pediatric deceased-donor livers were being transplanted into adults, with 25% of these livers never having been offered to a pediatric candidate.

The goal of acuity circles is to “improve access to organ and waitlist martially for pediatric candidates by changing their priority within the match run…and rethink about allocation as it applies to children,” said Dr Mogul.

Under acuity circles, organs are now offered to pediatric candidates in a greater geographic area before being offered to adult candidates.

Data from a SPLIT-funded study using a Liver Simulated Allocation Model (LSAM) to evaluate the projected impact of acuity circles found that overall, the projected number of waitlist deaths decrease for all groups, including adults, and the overall number of transplants went up for children. The number of days on the waitlist also went down for all age groups.

The LSAM projected near geographic variability resolution for adults, but some improvement is still needed to fix the geographic variability issue for pediatric candidates.

Dr Mogul said that the most exciting outcome from an equity standpoint was that up to 80% of pediatric organs were projected to stay with pediatric recipients; this was around 40% under the DSA system.

Mogul D. Acuity Circles: Impact on Outcomes for Pediatric Liver Transplant Candidates. Presented at: 2021 SPLIT Annual Meeting.