Geography must be considered in organ donation due to the length of time it takes to transport the organ from the donor to the candidate. The time the organ is outside the body plays an important role in a positive outcome.
Livers (all organs) are offered to the most critical patients first in a donor’s local area. This is also determined by their MELD (Measure of End-Stage Liver Disease) score. These patients are usually hospitalized in critical care and in imminent danger of dying due to liver failure. They are listed on a completely separate list called Status 1. If there are no such candidates in the local area (usually a state or large metro area), the liver is offered to Status 1 candidates in a regional area (there are 11 regions in the US). Note: A patient can be bumped to the Status 1 list and be returned to the regular blood-type compatibility list if their condition is stabilized.
The size of the organ is always considered. So, if the donor is under 18-years of age, children (under 11-years of age) and adolescents (age 12-17) are always consider (and rightly so) before adults (age 18 and over). Children 11 and under are prioritized on the PELD (Pediatric End-Stage Liver Disease) scoring system.
Once a donor is identified, the organs are offered in this order:
Status 1 (local area)
Status 1 (regional area)
Pediatrics (regional area)
Adolescents (local area)
Adults with a MELD of 15 or higher (local area)
Adolescents (regional area)
Adults with a MELD of 15 or higher (regional area)
Adults with a MELD of 14 or less (local area)
Adults with a MELD of 14 or less (regional area)
Then the organ is offered Nationally in the same order.
Since the PELD/MELD scoring system does not always represent the patient's true medical urgency, exceptions can be made to increase the score. The transplant team would have to file an exception to the UNOS review board. If the board accepts, the PELD/MELD would be increased and the patient would be reprioritized on the list.
I personally don't know what criterial would be required to increase the MELD score, but I'm certain a good doctor would know. If I get a chance, I will do some more research on this. You would also have to have a doctor willing to process the red tape. This goes back to my insistance that you (the patient) take as many family members to your follow-up appointments as possible. The show of force could make the difference in the doctor's willingness to take on the board.