Status: Public Comment
Sponsoring Committee: Thoracic Transplantation
Strategic Goal: Provide equity in access to transplants
Read the proposal (PDF; 01/2020)
Contact: Sara Rose WellsSubmit a comment
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At a glance
What is current policy and why change it?
Currently, when a transplant physician lists a candidate at a high urgency status (Status 1A or Status 1B) who does not meet the criteria for that status, they must submit justification for this exception to the OPTN for review by a Regional Review Board (RRB). Due to recent pediatric heart allocation changes, there has been an increase in pediatric candidates listed at higher statuses by exception, but pediatric transplant programs tend to be under-represented on RRBs.
What’s the proposal?
- Create a National Heart Review Board (NHRB) for Pediatric Candidates.
- Each active pediatric heart program would be able to appoint one primary and one alternate representative to serve one year terms.
- NHRB would review exception requests for Status 1A and Status 1B pediatric heart candidates.
- Requests would be assigned to nine randomly selected representatives.
- Decisions based on majority vote within three days.
- Denials can appeal to same group of reviewers.
- Additional denial can be appealed to workgroup made up of members of Thoracic Committee and Pediatric Committee with relevant expertise.
What’s the anticipated impact of this change?
- What it’s expected to do
- Improve quality and consistency in review of pediatric heart exceptions.
- Work towards ensuring more medically appropriate status listings for pediatric heart patients.
- What it won’t do
- It will not change the way exception requests for adult heart patients are reviewed.
Themes to consider
- How to ensure broad/equal representation on the NHRB
- How appeals should work
- What statuses should be reviewed
- Plan for tiebreakers
Terms you need to know
- Status: An indication of the degree of medical urgency for patients awaiting heart transplants. Status 1A is most urgent.
- Exception: When a physician places a candidate at a higher status even though the candidate does not meet the standard criteria in policy to automatically qualify for the status.
- Review Boards: Peer review panels established to review all urgent status listings for liver and heart candidates. The review boards reviews justification forms submitted by each center documenting the severity of the candidate's illness and justifies the status at which the candidate is listed. Thoracic review boards review listings for heart candidates in Status 1A and special case heart candidates in Status 1B. These boards also consider appeals of cases initially turned down for a particular medical urgency status.
- Click here to search the OPTN glossary.