Status 1A liver transplant candidates are given the highest medical priority for the allocation of deceased donor livers. Organ Procurement and Transplantation Network (OPTN) policy requires physicians to certify that a candidate has a life expectancy without a transplant of less than 7 days for that candidate to be given status 1A. Additionally, candidates receiving status 1A must have one of six medical conditions listed in policy. Using Scientific Registry of Transplant Recipients data from all prevalent liver transplant candidates from 2010 to 2020, we used a bias-corrected Kaplan–Meier model to calculate the survival of status 1A candidates and to determine their life expectancy without a transplant. We found that status 1A candidates have a life expectancy without a transplant of 24 (95% CI 20–46) days—over three times longer than what policy requires for status 1A designation. We repeated the analysis for subgroups of status 1A candidates based on the medical conditions that grant status 1A. We found that none of these subgroups met the life expectancy requirement. Harmonizing OPTN policy with observed data would sustain the integrity of the allocation process.

中文翻译：

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1A 级肝移植候选者无需接受移植的预期寿命


状态 1A 肝移植候选者在分配已故供体肝脏方面享有最高医疗优先权。器官获取和移植网络 (OPTN) 政策要求医生证明候选人在没有进行移植的情况下的预期寿命少于 7 天，才能获得 1A 状态。此外，获得 1A 状态的候选人必须患有政策中列出的六种健康状况之一。利用 2010 年至 2020 年所有流行肝移植候选者的移植受者科学登记数据，我们使用偏差校正的 Kaplan-Meier 模型来计算 1A 状态候选者的生存率，并确定他们在不接受移植的情况下的预期寿命。我们发现，1A 状态候选人在不进行移植的情况下的预期寿命为 24 天（95% CI 20-46），比 1A 状态指定政策要求的寿命长三倍多。我们根据授予 1A 状态的医疗条件重复了对 1A 状态候选人亚组的分析。我们发现这些亚组均不符合预期寿命要求。将 OPTN 政策与观察到的数据相协调将维持分配过程的完整性。