Impact of Model for End-stage Liver Disease Cutoffs on Liver Transplant Access in the United States: A Regression Discontinuity Design

MELD thresholds continue to influence LT access and donor quality/selection, creating artificial discontinuities and unintended disparity that misalign allocation with true disease severity. These findings support avoiding rigid score-based cutoffs not only in future US allocation models (eg, continuous distribution), but also in broader international allocation frameworks moving forward.