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Liver timeline

Increasing equity in liver transplants

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Timeline

The following timeline shows the major milestones in liver allocation and distribution policy development. Scroll to the bottom of the page for a text version of the timeline.

1987: First liver policy developed

First liver policy developed

1987
1999: Recommendations

Institute of Medicine allocation recommendations

1999
2000: OPTN Final Rule

HRSA releases OPTN Final Rule

2000
2002: Object medical urgency measurement

Objective measure of medical urgency replaces point system

2002
2005: Regional sharing for MELD scores of 15 or greater

Regional sharing for candidates with MELD scores of 15 or greater

2005
2010: Regional sharing for Status 1 candidates

Regional Sharing for Status 1 candidates

2010
2012: HHS advisory committee recommendations

HHS Advisory Committee on Transplantation recommendations

2012
2012: OPTN Strategic Plan

OPTN Strategic Plan – reduce geographic disparities

2012
2012: Measure of fairness

Board directs organ-specific committees to define measure of fairness

2012
2013: Revised policy broadens access

Revised policy broadening regional and national access for highly urgent liver candidates

2013
2014: liver redistricting concept paper

Liver Redistricting Concept Paper

2014
2014: Public forum on liver redistricting

Public Forum on Liver Redistricting in Chicago

2014
2015: 2nd public forum on liver redistricting

2nd Public Forum on Liver redistricting in Chicago

2015
2015: revised policy for liver candidates HCC exception scores

Revised policy for liver candidates with exception scores for hepatocellular carcinoma (HCC)

2015
2016: Additional element added to medical urgency calculation

Additional element added to medical urgency calculation

2016
2016: Initial public comment proposal

Initial public comment proposal

2016
2017: Second public comment proposal

Second public comment proposal

2017

Text version of liver timeline

1987

  • First liver policy developed
    Livers were allocated through a point system assigning relative weights for medical urgency, blood group, compatibility, logistic considerations and waiting time to patients within distinct distribution units.

1999

  • Institute of Medicine allocation recommendations
    IOM recommended establishment of liver allocation areas broad enough to provide for medically effective distribution of organs.

2000

  • HRSA releases OPTN Final Rule
    "Neither place of residence nor place of listing shall be a major determinant of access to a transplant."

2002

  • Objective measure of medical urgency replaces point system
    MELD/PELD score replaces statuses with a more objective way of measuring medical urgency. This change results in better transplant outcomes despite sickest first triage, and lower waitlist mortality.

2005

  • Regional sharing for candidates with MELD scores of 15 or greater
    Candidates with higher medical urgency (MELD/PELD of 15 or higher) are offered livers throughout the region before local, less urgent candidates.

2010

2012

  • HHS Advisory Committee on Transplantation recommendations
    Recommended that organ allocation should be evidence-based and not based on the arbitrary boundaries of OPOs or their DSAs. HRSA supports effective approaches to develop distribution systems that minimize this variation.
  • OPTN Strategic Plan – reduce geographic disparities
    Board adopted a strategic plan that included reducing geographic disparities in access to transplantation.
  • Board directs organ-specific committees to define measure of fairness
    Board agreed that observed geographic disparities in access to organ offers were unacceptably high and charges organ-specific committees to develop policy to minimize effects of geography.

2013

  • Revised policy broadens regional & national access for highly urgent liver candidates
    Decreased wait time, increased access and decreased waitlist mortality for candidates with a MELD of 35 or higher.

2014

  • Liver Redistricting Concept Paper
    The Liver Committee released a concept paper and questionnaire seeking public input on distributing livers over wider districts instead of traditional regions.
  • Public Forum on Liver Redistricting in Chicago
    The Liver Committee held a public forum to seek additional input regarding liver redistricting concepts. Workgroups were formed to study issues relating to potential redistricting.

2015

  • 2nd public forum on liver redistricting in Chicago
    Workgroup findings and modeling results were presented; additional modeling was requested to study potential impact of distribution within concentric circles surrounding donor hospital.
  • Revised policy for liver candidates with exception scores for hepatocellular carcinoma (HCC)
    Capped HCC exception points at 34 and added a 6 month delay before HCC points are initially awarded.

2016

  • Additional element added to medical urgency calculation
    Helps patients whose MELD will increase by adding serum sodium as an additional factor.
  • Initial public comment proposal
    The Liver Committee sought public feedback on a proposal to establish new districts for liver distribution. Based on public feedback, the committee chose to investigate other options for a future proposal.

2017

  • Enhanced liver distribution policy approved
    The revised policy will offer more transplant access to candidates at a greater medical priority level who are local to the donor hospital, whether they are inside or outside current regional boundaries.
  • National Liver Review Board approved
    The national board will replace the individual review boards in each of the 11 OPTN regions, creating greater consistency in assigning exception scores for medical conditions not assessed reliably by MELD or PELD scores.