الفهرس 
Acknowledgement
Scores for organ allocationOnly 14 pages are availabe for public view
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Abstract
Liver transplantation has had a profound impact on the care of patients with end-stage liver disease and is the most effective treatment for many patients with acute or chronic liver failure resulting from a variety of causes. For most patients with chronic liver disease, selection for transplantation depends on their risk of dying from the liver disease weighed against their risk of dying from the transplantation procedure and attendant medications.
Mortality risk scores have been helpful in determining when this risk of death without transplantation is greater than the risk after the procedure. The most widely used scores to determine prognosis in patients with chronic liver diseases include the prognostic model for end-stage liver disease (MELD), the Child-Turcotte-Pugh (CTP) classification as well as disease-specific indices for primary biliary cirrhosis and sclerosing cholangitis. Every model has its advantages and disadvantages. Till now, MELD score is considered an ideal survival model in comparison to either models/scores used in patients with liver disease. Its strengths derived from the robust statistical foundation in its development and the large number and variety of samples in which it was validated. Although patients with severe chronic liver disease have deteriorated health-related quality of life (HRQOL), this must be weighed carefully against the risk of death while waiting compared with the risk of death from the transplantation. There can be no quality of life for deceased candidates.
For some liver diseases, the benefit of liver transplantation cannot be weighed against the mortality risk from intrinsic liver disease. Therefore other methods, such as estimates of disease progression, must be used for proper selection of waiting candidates. Disease progression estimates are limited by lack of good natural history data.
Selection of candidates for liver transplantation is not necessarily linked to the timing of liver transplantation due to the severely constrained organ donor resource. This means that individual candidates cannot always receive a transplant at the optimal time for his or her benefit.
Efficient selection of liver transplantation candidates with acute liver failure is especially challenging because of the need to rapidly assess the probable natural course of the disease so that patients not likely to recover will receive transplant priority but those more likely to recover do not receive needless transplants.
Living donor liver transplantation improves the ability of the clinician to “time” the transplantation at the most advantageous point in disease progression for the waiting candidate. However, donor risks and informed consent must not be subjugated in an effort to maximize the timing benefit.
For decades, liver transplantation has been challenged by severe organ shortage and prolonged waiting time. To fairly allocate donor livers to transplant candidates, the policies of organ allocation have gone through various stages of evolution.
In Egypt, there are 7 centers for liver transplantation, all of them are in Cairo and Delta, with no centers in Upper Egypt inspite there is large number of patients with end-stage liver disease in this area. All of these centers are following the universal criteria for selection and timing for liver transplantation.
Every effort should be made to avoid deviation from strict criteria for liver transplant evaluation and listing.