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.

First liver policy developed

Allocated livers through a point system assigning relative weights for medical urgency, blood group, compatibility, logistic considerations and waiting time to patients within distinct distribution units.

1987

Institute of Medicine allocation recommendations

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

1999

HRSA releases OPTN Final Rule

“Neither place of residence nor place of listing shall be a major determinant of access to a transplant.”

2000

Objective measure of medical urgency replaces point system

MELD/PELD score replaces statuses with a more objective way of measuring medical urgency. Results in better transplant outcomes despite sickest first triage, and lower waitlist mortality.

2002

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.

2005

Regional Sharing for Status 1 candidates

Results in waitlist mortality reduction for status 1 recipients, especially pediatric recipients.

2010

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.

2012

OPTN Strategic Plan – reduce geographic disparities

Board adopted a strategic plan that included reducing geographic disparities in access to transplantation.

2012

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.

2012

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

Decreased wait time, increased access and decreased waitlist mortality for candidates with MELD more than or equal to 35.

2013

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.

2014

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.

2014

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.

2015

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

Capped points at 34 and added a 6 month delay before HCC points are initially awarded.

2015

Additional element added to medical urgency calculation

Helps patients whose MELD will increase by including serum sodium as an additional factor.

2016

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.

2016

Second public comment proposal

The Liver Committee sought public feedback on a new proposal to 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.

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

• Regional Sharing for Status 1 candidates
  Results in waitlist mortality reduction for status 1 recipients, especially pediatric recipients.

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.