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The number and type of human organ transplants have increased rapidly in recent years. However, the number of people awaiting a transplant greatly exceeds the availability of organs. Important, contentious questions have been raised about how donated organs should be allocated and by whom allocation policy should be made. This paper describes results of an analysis of 68,000 liver transplant waiting list records performed by an Institute of Medicine (IOM) committee. The primary findings were as follows: (i) waiting times are not a valid performance measure, (ii) current allocation policies fail to provide organs to the neediest patients, (iii) sharing organs across larger populations would advance the goals of transplantation, and (iv) enhanced government oversight would promote patients' interest and public health.