Recent attention has focused on allocation, debating optimal distribution of deceased donor livers to patients. The problems lie in the donor liver supply–demand mismatch, further amplified by lower donation rates in regions having more liver disease. In 2013, the United Network for Organ Sharing (UNOS) proposed changing the geographic basis for organ allocation, following a 2013 publication by Gentry et al (2) regarding optimization of organ allocation. A September 2014 UNOS Public Forum presenting the proposal met criticism that it focused on mathematical models, avoiding financial and operational implications (3). A 2015 UNOS Public Forum saw the discussion dominated by audience members’ concerns about the financial and operational burdens of the proposal.

The optimal distribution of deceased donor livers to patients can be best achieved by understanding the past, as current allocation methods may not be optimal for the future.

Organ Allocation: The Only Way to Predict Your Future Is to Know Your Past

Key Takeaway: The optimal distribution of deceased donor livers to patients can be best achieved by understanding the past, as current allocation methods may not be optimal for the future.