Matching organs. Saving lives.


National Liver Review Board to be implemented Jan. 31, 2019

Liver transplant program directors, surgeons, physicians, administrators, clinical coordinators and data coordinators

Implementation date:
January 31, 2019

The National Liver Review Board (NLRB) will begin operation on this date. The original NLRB proposal is addressed in this policy notice; some refinements were addressed in the liver distribution policy approved in December 2018, as noted in this briefing paper.

The system will collect additional data for certain standard exceptions, allowing more exceptions to be automatically approved. Requests for custom exceptions will be considered in relation to the median score at transplant (median MELD at transplant (MMaT) for recent MELD recipients listed at centers within a 250 nautical mile radius of your transplant program; national median PELD at transplant (MPaT) for all recent PELD recipients). UNOS will calculate and publish MMaT and MPaT scores approximately January 17 and update them approximately every 180 days thereafter.

NLRB members will use guidance documents available here to assess the most common types of exceptions.

Candidate exception scores that are current as of the implementation date will remain the same until the current exception expires. All requests for new or extension exception scores after that date will follow the new criteria and scoring model.

Find more specific information below about what will be different beginning Jan. 31.

What you should know about the NLRB

The NLRB will be comprised of three specialty boards: Adult HCC, Adult Other Diagnosis, and Pediatrics.

Every active liver transplant program may appoint a representative and alternate to each of the adult specialty boards. A liver transplant program with an active pediatric component may appoint a representative and an alternate to the pediatric specialty board.  If you have not already submitted your representative(s), you may do so using this form.

Please be aware of the new guidance and educate your staff on the new scoring for standardized exception requests.  Please also communicate with your candidates who have existing exception scores.

If you are submitting information for a standardized exception, please submit the required information in discrete data fields in UNetSM instead of the narrative form used up until NLRB implementation.


  • Various resources are available in the implementation toolkit. They will be updated and new resources will continue to be added in coming weeks.
  • Access all the available policy and system trainings in UNOS Connect from the course catalog; Liver category
  • National Liver Review Board Policy: MELD/PELD Exception Scoring
  • National Liver Review Board Policy: New Processes
  • NLRB training for review board representatives

If you have questions about how to submit exception forms, contact UNOS Customer Service at 800-978-4334.  For policy-related questions, send an e-mail to or call 844-395-4428.





Share This