Emerging Perspectives in TransplantationProcurement and allocation of donated organsFirst Look: One Year Since Inception of Regional Share 35 Policy

•Share 35 policy has not changed waitlist mortality rates since inception over a 1-year period.•The usage of high-risk organs has significantly increased.•There has been a significant increase in transplants in the MELD score ≥ 35 group.•Long-term graft and patient survival outcomes are unknown.

BackgroundMore than 10,000 patients are awaiting liver transplantation, and more than 1300 die waiting yearly. The Share 35 policy was implanted 1 year ago with expectations to decrease waitlist mortality. The purpose of our study was to look at waitlist outcomes and organ usage.MethodsWe compared data from the United Network of Organ Sharing before and after the initiation of Share 35, looking at waitlist mortality, organs shared with Model for End-Stage Liver Disease (MELD) score ≥35, organ discards, travel distance, cold ischemia time, MELD score at transplantation, donor characteristics, and waitlist times. The χ2 test was used to compare the data from two time periods.ResultsComparing the 1-year periods, we found no change in waitlist mortality rate; transplants in MELD score ≥35 increased from 19% to 27% and decreased in MELD score15 to 34 from 74% to 67%; high-risk donors increased from 13% to 17%; and a 40% decrease in time on the waitlist before removal because of death from 58 to 35 days.ConclusionsOne year since Share 35, there has been no change in waitlist mortality rate. Unfortunately, it will take several years to know the impact of Share 35 on changes in patient life-years saved.