The United States has lead the way in developing organ-sharing algorithms with emphasis on reducing waiting-list mortality.1 Allocation based on the Model for End-stage Liver Disease score has been a revolutionary measure, not just for upholding the principle of ‘sickest first’ before ‘best use,’ but also for successfully applying it across a vast nation. In this issue of Gastroenterology, Hsu et al2 report their analysis of liver offers to the pediatric liver transplantation waiting list over a 5-year period.