We presume that this deleterious outcome was responsible for the current rise in the MELD score cutoff enabling liver allocation. Recent decreases in the number of deceased donors resulted in the expansion of the waiting list pool of patients with very high MELD scores. However, in reality, the proportion of the statuses 2 and 3 patients was much greater than anticipated. Before the MELD score-based allocation system adoption, the new KONOS statuses 2 and 3 had been expected to cover approximately a half of the DDLT cases, with a considerable proportion of liver grafts allocated to status 4 patients carrying MELD scores between 21 and 30. The mean MELD score of DDLT recipients exceeded 36, suggesting that only patients with very high MELD scores were allocated to DDLT due to the severe organ shortage in Korea. In addition, the results of this study indicate that the Korean MELD score-based liver allocation system was greatly influenced by a serious shortage of deceased donors. indicated that MELD scoring significantly improved short-term survival of the sickest patients on the waiting list for LT. found that patient survival on the waiting list for LT remained unchanged for 1 year after the introduction of MELD scoring in Brazil. Although longer waiting time due to organ scarcity is a key factor, death rates in the mid-range MELD groups indicate that further audit of the care of patients with end stage liver disease is indispensable. concluded that MELD score was valid in Israel and superior to the CTP score for predicting waiting list mortality. reported that the MELD/PELD score-based system in the United States has been associated with reduced registrations and improved LT rates without increasing the mortality rates for individual groups of waiting candidates or changes in early transplant survival rates. Several studies have summarized the results following the introduction of MELD scoring in deceased donor liver organ allocation. Since the number of deceased organ donors cannot meet the demand for DDLT in critically ill patients, a priority allocation was made only for patients with the highest KONOS status. With the new MELD score-based allocation, the pool size was gradually expanded because patients were allowed to wait for prolonged periods until DDLT or death without LT. Paradoxically, this system was implemented to restrict the pool size of critically ill patients on the waiting list. In this CTP score-based allocation system, patients who did not receive DDLT within 2 weeks could not be indicated for priority allocation again, implying that if they did not receive LT during that time, most patients, except those who received living donor LT, died. One of the primary reasons underlying the change in the liver allocation system from the old CTP to the new MELD score-based system was that relisting was not allowed after the 2-week priority allocation in patients classified under the old KONOS status 1 or 2A. 2, indicating that the recipients with blood group O accounted for the greatest proportion in KONOS statuses 1 and 2. The KONOS status distribution according to the ABO blood groups is presented in Fig. Patients with blood group AB and blood groups B and O carried the longest and shortest mean waiting period until DDLT allocation, respectively. Furthermore, the comparison of the mean waiting periods revealed significant statistical differences (P=0.012). Patients with blood groups O and AB carried the highest and lowest mean MELD scores at DDLT allocation, respectively. The mean MELD scores’ comparison revealed significant statistical differences (P< 0.001). In all patients, the mean MELD scores’ distributions at initial enrollment and DDLT allocation and mean waiting period until DDLT according to the recipient ABO blood groups were the following: 30.6☗.7, 36.6±4.6, and 62.1☙8.2 days in blood group A 32.7☗.4, 37.6± 3.6, and 25.7☓8.1 days in blood group B 32.1☗.1, 38.8☒.7, and 26.0☓0.5 days in blood group O and 28.5☘.5, 34.8±5.5, and 68.4☑10.5 days in blood group AB, respectively.
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