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Board approves national liver review board and patient guidance

Richmond, Va. – The OPTN/UNOS Board of Directors, at its meeting June 5 and 6, approved a national system to assign liver allocation priority for candidates with exceptional medical conditions.

“While there have been review boards in each region to consider individual exception scores for liver candidates for a number of years, this has sometimes led to differences in how much priority candidates may get from one area to another,” said Stuart Sweet, M.D., Ph.D., OPTN/UNOS Board President. “The new system will create more consistency and will also scale its criteria to balance the priority between exception candidates and those with standard scores. This is a crucial step forward in addressing geographic disparities in liver transplant access. ”

The majority of liver transplant candidates receive an allocation score based on either the Model for End-Stage Liver Disease (MELD) or the Pediatric End-Stage Liver Disease (PELD) model. These scores estimate candidates’ short-term risk of death without receiving a liver transplant. While MELD and PELD provide reliable estimates for most liver candidates, others have diseases or unusual complications that the formulas do not capture as well. These candidates receive an “exception score” comparable to the degree of illness of MELD and PELD candidates.

The newly approved National Liver Review Board (NLRB) will replace the individual review boards in each of the 11 OPTN regions. Reviewers will be drawn from a nationwide pool of liver transplant physicians and surgeons, who will review exception requests on an anonymous basis for candidates not listed at the transplant program of any of the reviewers. The policy also establishes standard allocation point thresholds for a number of common medical conditions needing an exception score, as well as guidance documents for NLRB members to consult when considering a non-standard exception.

While no Board action was planned or taken to address liver distribution, the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee briefed the board on its development of a new policy proposal intended to reduce geographic disparity in liver candidates’ medical urgency scores at transplant. The committee is not currently considering an 8-district concept circulated for public comment in 2016.

In other action, the Board approved a guidance document to help transplant professionals discuss with transplant candidates the option of potentially receiving a transplant from a donor at potentially increased risk for disease transmission based on Public Health Service criteria.

United Network for Organ Sharing (UNOS) serves as the Organ Procurement and Transplantation Network (OPTN) by contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.

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