Drs. Locke (left) and Sheikh (right)Director of the Division of Transplantation Jayme Locke, M.D., MPH, and Assistant Professor Saulat Sheikh, M.B.B.S., were featured in Jama Surgery for their commentary “Leveraging Frailty to Mitigate Sex-Based Disparities in Access to Liver Transplant: Justice in Allocation.”

Their article discusses what Locke and Sheikh believe to be the root of sex-based disparities in liver transplantation­– serum creatinine level as a measure of renal dysfunction in MELD. MELD is Model for End-stage Liver Disease that was introduced in 2002 to ensure that the sickest patients were offered transplant first.

According to the article, MELD is a calculation based on objective laboratory data, including serum creatinine level. Despite the goal of defining an objective, equitable measure of disease severity, MELD-based allocation inadvertently introduced sex-based disparities in liver transplant, with women experiencing higher wait list mortality and lower likelihood of transplant compared with men. These sex-based disparities may be the result of including serum creatinine level as a measure of renal dysfunction in MELD.

Locke and Sheikh conclude the article by stating the results of the study offer an opportunity to address the crucial issue of sex-based disparities in access to a life-saving therapy for patients with end stage liver disease. As a means to improve, they believe we should examine LFI as an objective measure of disease severity that can be incorporated into our existing MELD-based allocation system.

“Correcting sex-based disparities in liver transplant is a passion of mine,” said Sheikh. “In all of these transplantation policy discussions or model gaps that we find, we are not just talking about numbers– these are real patients whose lives depend on us acting swiftly to correct model mistakes and enact fair policy.”