The effect of acuity circles on deceased donor transplant and offer rates across meld and exception statuses

Purpose: Acuity circles (AC) allocation was implemented on February 4, 2020. AC significantly changed the relative priority of candidates with allocation PELD/ MELD scores of 29 to 34. We therefore performed a difference-in-differences analysis for the effect of AC on adjusted deceased donor transplant and offer rates across PELD/MELD categories. Methods: The before-AC period was February 4, 2019 to February 3, 2020, and the after-AC period was February 4 to March 12, 2020, the day before the national declaration of emergency due to COVID-19. Deceased donor transplant rates used active candidate time on the waiting list during the study period. The deceased donor offer rate was the number of offers in the first 10 spots of match run a candidate received per person-year. Only offers before the final acceptance were included. Transplant and offer rates were adjusted for other candidate characteristics. Results: Candidates with PELD/MELD 29-32 and PELD/MELD 33-36 had larger differences in transplant rates before and after AC than candidates with PELD/MELD 15-28, while other PELD/MELD categories also had larger but non-significant dif Admin ferences compared to candidates with PELD/MELD 15-28 (Figure 1). In contrast, all candidates with PELD/MELD 29 and higher had dramatically larger offers rates before and after AC than candidates with PELD/MELD 15-28 (Figure 2). Conclusions: Taken together, the implementation of AC increased the relative access to deceased donor transplant for candidates with PELD/MELD of 29-36 without reducing access for candidates with higher allocation priority.