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Clarification of pre existing liver disease

Proposal Overview

Status: Public Comment

Sponsoring Committee: Liver and Intestinal Organ Transplantation Committee

Strategic Goal: Promote the efficient management of the OPTN

View the Board Briefing Paper (11/2019)

Read the proposal (PDF; 8/2019)

Contact: Betsy Gans

eye iconAt a glance

You may be interested in this proposal if

  • You are a liver program director
  • You are a liver program administrator
  • You are a liver clinical coordinator

Here’s what we propose and why

  • OPTN policy allows patients meeting specific criteria for fulminant hepatic failure to be eligible for listing as Status 1A when patients are “without pre-existing liver disease”.
  • The policy is ambiguous regarding whether or not receipt of a prior liver transplantation constitutes a “pre-existing liver disease”.
  • Patients who meet the criteria for a Status 1A listing due to fulminant hepatic failure, but have received a previous liver transplant, should be able to be listed as Status 1A regardless of their receipt of a prior transplant.
  • This proposal will clarify policy language so that pre-existing liver disease does not include those who received a prior liver transplant.

Why this may matter to you

The policy language will be clear so that liver programs understand if their candidates meet criteria to be eligible for listing as a Status 1A when they have had a prior liver transplant.

Tell us what you think

  • Will this change make the policy more clear?

Comments

OPTN Region 4 | 08/30/2019

Strongly support (8), Support (12), Neutral/Abstain (0), Oppose (0), Strongly Oppose (1)

OPTN Region 7 | 09/03/2019

Region 7 voted as follows: 4 strongly support, 10 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose

OPTN Region 3 | 09/07/2019

No comments or questions Strongly support (8), Support (22), Neutral/Abstain (4), Oppose (0), Strongly Oppose (0)

OPTN Region 2 | 09/20/2019

Region 2 voted as follows: Strongly support (11), Support (11), Neutral/Abstain (1), Oppose (0), Strongly Oppose (0)

OPTN Region 1 | 09/24/2019

Region 1 voted as follows: Strongly support (4), Support (7), Neutral/Abstain (2), Oppose (0), Strongly Oppose (0)

OPTN Region 11 | 09/26/2019

Strongly support (12), Support (15), Neutral/Abstain (1), Oppose (0), Strongly Oppose (0)

Region 8 | 09/27/2019

Region 8 voted as follows: Strongly support (5), Support (15), Neutral/Abstain (1), Oppose (0), Strongly Oppose (0)

American Society of Transplantation | 09/30/2019

The American Society of Transplantation is supportive of the proposed clarification for pre-existing liver disease as written and offers no further comment.

Region 10 | 10/01/2019

Non-Discussion Agenda Strongly support (12), Support (9), Neutral/Abstain (1), Oppose (0), Strongly Oppose (0)

Kim Rallis | 10/01/2019

I support the proposed clarification for pre-existing liver disease.

Society for Pediatric Liver Transplant | 10/02/2019

The Society for Pediatric Liver Transplant supports this proposal. The new proposal will ensure that patients with a history of liver transplantation, who have maintained normal graft function with no evidence of liver disease, have the fair opportunity to be listed as status 1A if they do develop acute fulminant liver failure. This clarification will help appropriately prioritize and care for pediatric liver transplant recipients who develop liver disease in their graft that meets criteria for acute liver failure. This occurs rarely, but when it does timely re-transplant is critical to avoid accumulating morbidity and impairment for the child. This clarification will avoid delay or confusion, and optimize the care of this patient population with a timely liver re-transplant.

Region 6 | 10/02/2019

Strongly support (19), Support (26), Neutral/Abstain (3), Oppose (0), Strongly Oppose (0)

Region 5 | 10/02/2019

Intestinal Organ Transplantation Committee Strongly support (19), Support (26), Neutral/Abstain (3), Oppose (0), Strongly Oppose (0)

American Society of Transplant Surgeons | 10/02/2019

The American Society of Transplant Surgeons (ASTS) thanks the OPTN Liver and Intestinal Organ Transplantation Committee for their work on this policy proposal. ASTS supports the committee’s recommendations as written for patients with a diagnosis of fulminant liver failure and their qualifications for Status 1A on the waiting list.

OPTN Region 9 | 10/02/2019

Region 9 voted as follows: Strongly support (6), Support (6), Neutral/Abstain (0), Oppose (0), Strongly Oppose (0)