MELD Exceptions for Hepatocellular Carcinoma: Regional Variations in the Impact of the Share 35 Liver Allocation Policy.

Historically, the OPTN liver allocation policies have favored candidates listed with MELD exception scores, and the use of exceptions has increased each year since the inception of the MELD era. The implementation of Share 35 and other recent changes in OPTN liver allocation policies have reduced the preference for MELD exception candidates to some extent, but the nature and degree of the impact appears to vary widely from one region to another. This report emphasizes the geographic inequities and regional variations in transplant practices, with a focus on liver transplant candidates with hepatocellular carcinoma exceptions, and highlights the need for strategies to promote equitable organ distribution across geographical regions and patient conditions.