The document establishes the more suitable technologies for diagnosis, the criteria that should be applied to reach a 100% specificity, and how to define the tumor stage. It is crucial to decide patient prioritization or when a tumor has progressed beyond what is accepted to proceed with a transplant. Regarding priority policies it should be noted that in the United States they are based in tumor burden defined by radiology and the transplant is not indicated when it exceeds a determined threshold.
The group led by Dr. Jordi Bruix has become a world leader in developing and validating radiology based diagnostic criteria. Ultimately, these criteria have resulted in recommendations included in Spanish, European and American diagnosis and treatment guidelines for liver cancer.
All these aspects are critical to ensure an accurate indication of transplantation in patients with liver cancer, so that the few available livers are correctly used. Standardizing the technological requirements and criteria to be used is essential to prevent heterogeneity among different groups of transplant candidates that could result in a lack of equity in the organ distribution. This was the fundamental motivation of UNOS when the process started, and certainly similar processes will be started elsewhere.
Article reference: Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS Policy for LiverTransplantAllocation: Standardization of LiverImaging, Diagnosis, Classification, and Reporting of Hepatocellular Carcinoma. Radiology. 2013 Feb;266(2):376-82. doi: 10.1148/radiol.12121698