Board approves liver allocation policy refinements

Published on: Thursday, November 15, 2001

Alexandria, Va. - The OPTN/UNOS Board of Directors, at its semi-annual meeting here today, unanimously approved a significant refinement to the national policy for matching donated livers with patients awaiting transplants, which should better identify urgent patients and reduce deaths among patients awaiting liver transplants. For all but the most severe and acute cases of liver failure, patients' priority for a transplant would be based primarily on a formula that calculates their short-term risk of death without transplantation.

The formula for adult patients is known as the Model for End-Stage Liver Disease (MELD). A companion formula for children is known as the Pediatric End-Stage Liver Disease model (PELD). Each is based on common, objective laboratory tests and would categorize patients on a continuous scale of urgency.

"We believe this new system is objective, it will save lives on the waiting list, and it allows flexibility for additional enhancement," said UNOS President Jeremiah G. Turcotte, M.D.

Current liver allocation policy categorizes liver patients into four urgency categories, with waiting time as a tiebreaker. The revised system would replace all but the highest medical urgency category (Status 1) with a continuous score calculated by MELD or PELD. Those with higher scores are at higher risk of death without a transplant within three months and would receive first consideration for liver offers. Waiting time would still be used as a tiebreaker, but as there are a larger range of values (from 6 to 40 under MELD), these tiebreakers would be needed less often.

The policy is scheduled for implementation in early 2002 and will be submitted to the Secretary of Health and Human Services for approval for enforcement under federal regulation. A transition procedure will allow patients listed upon implementation to retain their previously earned waiting time for a defined period of time. If their priority under MELD/PELD exceeds their priority under the current system before the end of that time frame, their priority would then be calculated under the new system.

The performance of the MELD/PELD system will be assessed and any needed modifications applied to benefit patients' needs, said Richard Freeman, M.D., chair of the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee. "MELD and PELD are objective and flexible. They are based on a calculation of objective lab standards. As we gain real-life experience using the system, we can adjust it quickly if needed to make sure it is providing optimal benefit."

"We have taken extensive efforts to involve the patient community in this proposal," said Deborah Surlas, R.N., chair of the OPTN/UNOS Patient Affairs Committee. "The Patient Affairs Committee, which includes transplant recipients and donor family members, and the patient representatives on the Board of Directors fully support this life-saving policy enhancement."

In other action, the Board approved a process to facilitate the use of donor kidneys that are traditionally difficult to place because of some increased risk of eventual graft loss. Such kidneys would be offered only to patients who agree to receive them, and the facilitated placement is expected to result in a greater number of kidney transplants performed.

The United Network for Organ Sharing (UNOS), a nonprofit organization, maintains the national Organ Procurement and Transplantation Network under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services. UNOS brings together medical professionals, transplant recipients and donor families to develop organ transplant policy on behalf of the Organ Procurement and Transplantation Network (OPTN). UNOS provides the OPTN with a functional, effective management system incorporating the UNOS Board of Directors, committees and regional membership structure to operate OPTN elements and activities.