Board approves policy to increase liver transplant benefit

Published on: Thursday, June 24, 2004

Minneapolis - The OPTN/UNOS Board of Directors, at its meeting June 24-25, approved a policy revision to better ensure that donated livers are offered to transplant candidates with greater potential medical benefit. Candidates who meet or exceed a defined medical urgency score will be considered for organ offers from a broad population region before any less urgent candidates in a local area.

"Our goal is to direct more livers to those more likely to benefit if transplanted in a timely manner, as compared to those who are currently less ill," said OPTN/UNOS President Russell Wiesner, M.D.

Since 2002, liver transplant candidates have been assigned an urgency status based on objective medical tests to determine their short-term risk of death without a transplant. One formula, known as MELD (Model for End-Stage Liver Disease), is used for adult patients; a similar formula, called PELD (Pediatric End-Stage Liver Disease model), is used for children. Each formula generates a defined score, and candidates with higher scores are given more priority for medically suitable livers.

Except for a select group of extremely urgent candidates, donated livers traditionally have been offered first to all compatible patients in a local area surrounding the donor site, then to a region of the country (the United States is divided into 11 allocation regions), then nationwide. The revised policy changes the allocation sequence for patients with a MELD or PELD score of 15 or higher. After local candidates with a score of 15 or higher are considered, livers will be offered to those in the larger region with a score of 15 or higher. Only if no more medically urgent candidates are found, local candidates with a score lower than 15 will be considered.

Currently, approximately 80 percent of liver recipients have a MELD or PELD score of 15 or greater at the time of their transplant. Modeling of the revised policy suggests that transplants for candidates of similar urgency will increase by 11 percent.

The board also voted to expedite discussion of potential policy revisions addressing the use of livers from pediatric donors for pediatric transplant candidates. “Because adult and pediatric candidates are prioritized by different measures, we want to make sure that both have an equal opportunity to receive an organ offer at a similar level of medical urgency,” said Dr. Wiesner.

"The unfortunate shortage of donated organs continues to force us to make difficult choices regarding which patients are in greatest need."