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Board approves enhanced liver distribution system

Published on: Sunday, December 3, 2017

Atlanta – The OPTN/UNOS Board of Directors, at its meeting December 4, approved a set of policy amendments to reduce geographic differences in liver transplant candidates’ access to a timely transplant.

“Today’s action is an important step in enhancing equity for liver transplant candidates nationwide,” said Yolanda Becker, M.D., president of the OPTN/UNOS Board of Directors. “For many years, there have been considerable differences from one area of the country to another in terms of how sick most liver candidates need to be before they are likely to get a transplant.  The revised policy reduces the effect of geography on transplant access and puts more appropriate emphasis on medical criteria that save and lengthen lives.”

The policies approved by the Board include the following key provisions:

  • Additional transplant priority (equivalent to 3 MELD or PELD points) will be awarded to liver candidates with a MELD or PELD of at least 15, and who are either within the same Donation Service Area (DSA) as a liver donor or are within 150 nautical miles of the donor hospital but in a different DSA. 
  • Adult candidates who have a calculated MELD score of 32 or higher, as well as pediatric candidates younger than age 18 with a MELD or PELD score of 32 or higher, would be prioritized for organ offers.
  • Livers from deceased donors who are age 70 or older, or who die of cardiorespiratory death, would not be subject to offers to the expanded DSA plus proximity circle.  Livers from donors with these medical characteristics are most often transplanted at hospitals nearby to the donor hospital.

Simulation modeling of the likely effects of the revised system suggests it will decrease pre-transplant deaths among liver candidates and increase transplant access for candidates younger than age 18. The modeling does not suggest the system will greatly affect transplant access based on candidates’ insurance type (public or private). Similarly, the modeling does not suggest the system will greatly affect transplant access whether candidates live in urban settings as opposed to suburban/rural areas.

“We will closely study the effects of the system, even prior to implementation and continuing as long as it remains in place,” added Dr. Becker. “Every transplant policy is reviewed for intended and unintended effects.  Through the OPTN policy-making process, we’ll continue to seek ways to make the policy work most effectively and address any issues that suggest it’s not giving everyone similar benefit.”

The action is the result of a five-year process of study and discussion. (See a timeline of key events in development of liver policy.)  The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee held two public forums and considered several distribution concepts.  The proposal approved by the Board was initially distributed for public comment in July 2017; several details were amended as a result of public input.

An implementation date for the new system has yet to be established; it will require time to allow for system programming and testing, as well as education for donation and transplantation professionals.

United Network for Organ Sharing (UNOS) serves as the national Organ Procurement and Transplantation Network (OPTN) under contract with the Department of Health and Human Services, Health Resources and Services Administration. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.