Which ABO-matching rule should be the decisive factor in the choice between a highly urgent and an elective patient?

ABO blood group matching policy between donor and recipient is a key element of organ allocation. Unequal distribution of the ABO blood groups in the population can lead to inequities in the distribution of organs to potential recipients. Furthermore, High Urgency liver transplant candidates might compromise the chances of transplantation for the elective patients. To compare the influence of the various ABO blood group matching policies on the transplantation rate of HU patients and on the subsequent donor liver availability for elective patients, a simulation study was undertaken. The study shows that in the Eurotransplant liver allocation program, a restricted ABO-compatible matching policy for HU liver patients offers the highest probability of acquiring a liver transplant, for both High Urgency- and elective patients, irrespective of their ABO blood group. A simulation study once again proved to be an elegant tool for objectively analysing various options in a complex organ allocation algorithm.