Purpose of review: United States has seen several significant changes in liver allocation. The aim of this review is to focus on those changes.
Recent findings: The success of liver transplantation led to its wider applicability for patients with end-stage liver disease. This success meant ultimately more patients were in need of transplantation, however, there was a limited availability of cadaveric organs. A system of prioritization was critical to reconcile the disparity between supply and demand of organs for liver transplantation. Liver allocation system has continuously evolved since inception. Implementation of the Model for End-Stage Liver Disease (MELD)-system of allocation occurred in 2002. Since then several 'tweaks' have been made to the allocation system. Most recently, United Network for Organ Sharing made significant changes to the liver-allocation policy to promote a broader sharing of livers. This policy eliminates the use of donor service areas (DSAs) and regions, and is consistent with direction given by the US Department of Health and Human Services Final Rule. This policy is awaiting implementation.
Summary: An ideal allocation policy would be fair, equitable and significantly reduce the waitlist mortality while simultaneously improving post transplantation outcomes. The impact of the recent changes in liver allocation on landscape of liver transplantation in United States is eagerly awaited.