First consensus document of waiting list prioritization for liver transplantation by the Spanish Society of Liver Transplantation (SETH)

Abstract

Consensus; Waiting list prioritization; Liver transplantation

Consens; Llistes d'espera; Trasplantament hepàtic

Consenso; Listas de espera; Trasplante hepático

Spain is worldwide leader in deceased donation rates per million habitants and count on a strong network of twenty-five liver transplant institutions. Although the access to liver transplantation is higher than in other countries, approximately 10% of patients qualifying for liver transplantation in Spain will die in the waiting list or would be excluded due to clinical deterioration. A robust waiting list prioritization system is paramount to grant the sickest patients with the first positions in the waiting list for an earlier access to transplant. In addition, the allocation policy may not create or perpetuate inequities, particularly in a public and universal healthcare system. Hitherto, Spain lacks a unique national allocation system for elective liver transplantation. Most institutions establish their own rules for liver allocation and only two autonomous regions, namely Andalucía and Cataluña, share part of their waiting list within their territory to provide regional priority to patients requiring more urgent transplantation. This heterogeneity is further aggravated by the recently described sex-based disparities for accessing liver transplantation in Spain, and by the expansion of liver transplant indications, mainly for oncological indications, in absence of clear guidance on the optimal prioritization policy. The present document contains the recommendations from the first consensus of waiting list prioritization for liver transplantation issued by the Spanish Society of Liver Transplantation (SETH). The document was supported by all liver transplant institutions in Spain and by the Organización Nacional de Trasplantes (ONT). Its implementation will allow to homogenize practices and to improve equity and outcomes among patients with end-stage liver disease.

The Spanish Society of Liver Transplantation (SETH) covered the expenses of the consensus meeting, which took place on the 26th of April 2024, in Madrid. The GEMA project was funded by the “Ministerio de Ciencia e Innovación (Spain)”, by the “Instituto de Salud Carlos III” (Proyecto PI22/00312), and co-funded by the European Union. None of the funding agents had any role in the elaboration of the present manuscript, nor in its content. The SETH consensus group would like to acknowledge Mrs. Paloma Bellés for her excellent labour as lead of the SETH technical secretariat.