Utility of Liver Transplantation Within the Bounds of Non-futility

Purpose of Review: To evaluate the measures of utility of liver transplant within the bounds of non-futility for controversial and high-risk scenarios associated with greatest transplant benefit and also possibilities of high futility. Recent Findings: Liver organ allocation policies are routinely adjusted to be in line with the Final Rule, maximizing transplant opportunities and minimizing futile transplants. Transplanting patients with high survival benefit is the construct of the liver allocation models with “sickest first” approach, but such policies have unintended consequences of futile transplants which raise ethical controversies and moral burdens on transplant physicians. Summary: Various adjustments are proposed to make the liver organ allocation models effective in high-risk scenarios which yield greatest transplant benefit for patients and satisfaction for the transplant physicians while minimizing disappointment among them from reduced futile efforts. They also offer ethical and effective allocation strategies of scare medical resource, i.e., liver.