Sponsoring Committee: Liver and Intestinal Organ Transplantation
Strategic Goal: Promote the efficient management of the OPTN
Read the proposal (PDF; 01/2020)
View the Board Briefing Paper (PDF; 6/2020)
View the Policy Notice (PDF; 6/2020)
Contact: Betsy Gans
Policy 9.4.A: MELD or PELD Score Exception Requests: Implemented
Policy 9.4.D: Calculation of Median MELD or PELD at Transplant: Implemented
National Liver Review Board Guidelines: Implemented
Guidance to Liver Transplant Programs and the National Liver Review Board for Adult MELD Exception Review: Implemented
Guidance to Liver Transplant Programs and the National Liver Review Board for Adult MELD Exceptions for Hepatocellular Carcinoma (HCC): Implemented
Policy 9.4.C: MELD or PELD Score Exception Extensions: Board approved and pending implementation
Policy 9.5.I.vii: Extensions of HCC Exceptions: Board approved and pending implementation
At a glance
What is current policy and why change it
When a transplant program believes that a liver candidate’s model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score does not accurately reflect the candidate’s medical urgency, they may request a MELD or PELD score exception. The National Liver Review Board (NLRB) is responsible for reviewing exception requests and either approving or denying the requested score. Since implementation, the transplant community and the OPTN Liver and Intestinal Organ Transplantation Committee (Liver Committee) have noted numerous ways to improve the NLRB in its goal to provide more efficient and equitable access to transplant.
What’s the proposal?
- To improve the NLRB by:
- Automatically granting extension requests for Hepatocellular Carcinoma (HCC) candidates, as long as they meet the standard extension criteria and are requesting a policy-assigned score.
- Clarifying the update schedule for median MELD at transplant and median PELD at transplant.
- Updating operational guidelines to include:
- Language instructing review board members on how to evaluate candidates with unique situations.
- Adjusted threshold for removing inactive reviewers.
- Clarification that the Liver Committee may delegate authority for final appeal review to a subcommittee.
- Updates to guidance documents to include:
- Recommendations for secondary sclerosing cholangitis (SSC) and adults with metabolic disease.
- Removing unnecessary language for portopulmonary hypertension (PH).
- Clearer guidance for handling candidates with history of hepatocellular carcinoma (HCC).
What’s the anticipated impact of this change?
- What it’s expected to do
- Make the NLRB more transparent, efficient, and equitable.
- Increase transparency in the update schedule of score changes.
- Increase the likelihood that candidates with similar clinical characteristics are treated in a similar fashion.
- What it won’t do
- Will not impact any specific patient group such as pediatric candidates, minority candidates, sensitized candidates, or living donors.
- There is no anticipated negative impact for any group.
Themes to consider
- MELD or PELD score recommendations in guidance documents
- NLRB voting thresholds
- How to improve the NLRB system
Terms you need to know
- MMaT: Median Model for End-Stage Liver Disease (MELD) at Transplant. The NLRB awards exception points for candidates 18 years or older relative to the MMaT for the area where the candidate is listed. This ensures that exception candidates are assigned scores that reflect the candidate pool in the area that they are listed.
- MPaT: Median Pediatric End-Stage Liver Disease (PELD) at Transplant. The NLRB awards exception points for candidates less than 18 years old relative to the MPaT for the nation. This ensures that pediatric exception candidates are assigned scores that reflect the pediatric candidate population across the nation.
- Exception Points: Additional points added to a MELD or PELD score for a candidate by the NLRB to more accurately reflect the candidate’s medical urgency.
- Click here to search the OPTN glossary.