The proposal being considered to equalize access for women improves the c-statistic, a discrimination measurement, for both men and women, so the new proposed system works better for everyone. Women needing liver transplant, therefore, bore the implications of MELD's gender bias through living with illness longer, a higher death rate, lower transplant rates and likely longer hospital stays, per Dr. Heimbach, indicating that laboratory results have verified this issue. "Creatinine doesn't accurately estimate kidney function in women - it works better in men," says Dr. This factor, along with overprioritization of access for patients with hepatocellular carcinoma and the fact that women's size - typically smaller than men - means they cannot be eligible for all of the available livers, led to about 10% to 15% increased death risk for women versus men. Creatine differences, therefore, made this lab test less accurate in women, as it is less able to identify poor renal function in women, and this led to women's waitlist underprioritization as the scores did not accurately predict their degree of illness and subsequent risk of death. Because women have less muscle than men, they do not produce equivalent creatinine volumes. Multiple factors impact the current MELD scoring gender bias the crucial one is using creatinine, a muscle metabolism byproduct utilized to estimate kidney function, as one of the values used to calculate the overall priority score. Factors contributing to gender bias in current MELD scoring and MELD 3.0's correction Kamath and Heimbach, among several other co-authors, on a revised scoring system version correcting the disparity for women introduced by the original MELD score model had been just completed and published and was ready for consideration, so the timing was finally aligned. Kim and Kwong from Stanford with contributions from Drs. When the system finally was revised to address geographic disparity in access to liver transplant with the adoption of a new circle-based organ distribution system in February 2020, an opportunity finally arose to address the long-standing disparity in access to liver transplant experienced by women. Heimbach indicates that remedying MELD's geographic disparities took longer than national transplant leadership anticipated, lasting approximately eight years. Though Mayo Clinic transplant specialists and others published content about MELD's gender-related disparities, change has been slow, in part because other priorities - such as addressing the complex topic of geographic disparity in access to transplant - took priority, according to Dr. However, beginning in 2008, multiple studies recognized liver transplant selection disparities between male and female patients. The MELD system was not intended to favor men needing liver transplant, and the system's sex-based disparities were not anticipated, says Dr. Kamath, M.D., gastroenterologist at Mayo Clinic's campus in Minnesota, was one of the creators of the MELD scoring system in 2002, originally named the Mayo End-Stage Liver Disease score. Unfortunately, this system has performed less well for female waitlisted candidates, who have experienced 15% lower transplant rate and significantly higher waitlist mortality compared to males. The MELD-based allocation system used since 2002, with a revised version adopted in 2016, has been effective in reducing waitlist mortality overall by prioritizing the most urgent candidates for transplant. Recognition of MELD's gender bias and movement toward resolution
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