Board approves policies to benefit children who need livers, kidneys

Published on: Friday, November 19, 2004

Reston, Va. -- The OPTN/UNOS Board of Directors, at its semi-annual meeting today, adopted policy revisions to optimize the chance for children to receive timely liver and kidney transplants. The new policies restructure the way pediatric candidates are considered for kidney and liver organ offers.

"Children face special risks from end-stage organ disease, such as growth failure or neurologic complications," said OPTN/UNOS President Robert Metzger, M.D. "As we make ongoing improvements to organ allocation policy, we want to ensure that children get the opportunity they need. These measures should reassure people awaiting transplants and those who wish to become donors that we are using donated organs responsibly."

Livers from donors younger than 18 will continue to be offered to the most urgent (Status 1) children and adult patients, first locally and then within one of 11 regions nationwide. Under the new policy, pediatric donor livers next will be offered in the following order:

• candidates age 11 or younger within the donor's region
• local adolescent patients with a medical urgency score of 15 or higher on a 40-point scale
• local adult candidates with a score of 15 or higher
• regional adolescent patients with a score of 15 or higher
• regional adult candidates with a score of 15 or higher
• remaining candidates locally and regionally, with adolescents receiving priority over adults

The Board also separated the criteria for the most urgent category of pediatric liver candidates (Status 1) into two subgroups to ensure that the candidates who are in the utmost medical urgency receive first consideration for donated livers. Both children and adults can qualify as Status 1 if they are at imminent risk of death without a transplant.

The revised kidney policy replaces an earlier system of allowing children extra allocation points based on their age. Kidneys from donors younger than age 35 will be offered to pediatric candidates before any adult patients, with the following exceptions:

• a perfect or nearly perfect immune system match between donor and candidate
• candidates whose immune sensitivity limits the number of medically suitable offers
• candidates awaiting other organs in addition to a kidney
• candidates who have previously been a living organ donor

The revisions will be made effective after programming into the computerized organ matching system. "We have done extensive research and modeling to study the likely effects of these policies," said Dr. Metzger. "We found that these revisions will increase transplant rates for children without shifting large numbers of donated organs away from adults. But to meet the needs of all candidates, we continue to rely on the commitment of those who choose to save lives through organ donation."

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