in focus
Liver transplant volume in most states equivalent to or better than prior two years.
![IF-liver-2yr-4point3percent 2 years since implementation: 4.3 increase in deceased donor liver-alone transplants](https://unos.org/wp-content/uploads/IF-liver-2yr-4point3percent.png)
In the two years following the launch of the national liver allocation policy based on acuity circles, nearly 15,300 deceased donor liver-alone transplants were performed nationwide. This was an increase of 4.3 percent over the corresponding two-year period before implementation.
A key focus in monitoring the policy’s performance has been its effect on transplant volume in various geographic areas. At two years post-implementation, the policy has shown no significant change overall in the number of deceased donor transplants performed in the states where a liver transplant program is based.
The attached figure shows deceased donor liver transplant volume for each state with at least one liver transplant program, comparing 24-month eras before and after policy implementation. It indicates the following trends:
- Nearly half of the states (shown in green) experienced a net change in volume of no more than 10 percent, either positive or negative. (Keep in mind that percent change is relative to overall volume; states with a higher baseline transplant volume may be less likely to experience major percentage shifts.)
- Of the states where there was a volume difference of more than 10 percent, more experienced a substantial increase than a substantial decrease.
Proportion of states experiencing a given percent change in number of deceased donor liver-alone transplants pre- to post-acuity circles
A key focus in monitoring the policy’s performance has been its effect on transplant volume in various geographic areas.
Proportion of states
![Proportion of states experiencing a given percent change in number of deceased donor liver-alone transplants pre- to post-acuity circles. Vertical axis is proportion of states with labels for 100%, 75%, 50%, 25% and 0%.](/wp-content/uploads/chart2-proportion-states-percent-change-deceased-liver-alone-transplants.jpg)
Percent change in number of deceased donor liver-alone transplants post- vs. pre-acuity circles
+20% or larger increase
+10% to +20% increase
increase or decrease no larger than 10%
-10% to -20% decrease
-20% or larger decrease
Only 40 states have transplant programs.
The specific comparison for each state is listed in Table 87 of the two-year monitoring report. The Kruskal-Wallis test indicated that there was not a statistically significant change pre- to post-policy in the number of deceased donor, liver-alone transplants performed in each state (x21=0.0514, p=0.821). In addition, Figure 24 of the two-year monitoring report displays a scatterplot by state comparing adult liver transplant volume before and after policy implementation.
Source: “Two Year Monitoring Report of Liver and Intestine Acuity Circle Allocation: Removal of DSA and Region as Units of Allocation,” data report presented to the OPTN Liver and Intestinal Organ Transplantation Committee August 5, 2022.
Note: Much of the post-transplant policy period has coincided with the national state of emergency declared March 13, 2020, due to the COVID-19 pandemic.
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