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Board endorses further development of liver urgency scale

Published on: Friday, June 29, 2001

San Diego -- The OPTN/UNOS Board of Directors, at its semi-annual meeting June 28 and 29, endorsed further development of a proposed policy enhancement to prioritize liver transplant candidates by a clinically based formula that indicates their short-term risk of death without a transplant. This proposed policy is expected to reduce deaths on the liver waiting list.

At its meeting in November 2000, the OPTN/UNOS board recommended that the Model for End Stage Liver Disease (MELD) be incorporated into liver policy proposed for final approval by the U.S. Department of Health and Human Services (HHS). At the same time, the board directed UNOS to collect additional data to further study and validate the predictive value of the model.

Data presented by the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee suggested that MELD functions well in assessing the relative medical urgency of adult liver transplant patients, although refinements may be necessary to address specific issues for pediatric patients.

"Transplant patient representatives to the board and the OPTN/UNOS Patient Access Task Force strongly supported this initiative," reported John Newmann, Ph.D., MPH, chairman of the task force.

"We feel the follow-up data presented to the board support a decision to move ahead with this life-giving approach," said UNOS President Patricia Adams, M.D. "At the same time, there are some additional medical and technical issues to be resolved." A formal proposal based on additional refinements is expected to be presented to the OPTN/UNOS board at its November meeting and could go into effect after final approval.

The MELD formula would assign priority to liver transplant candidates based on a series of objective medical tests. While as proposed it would not replace medical criteria for the most urgent (Status 1) patient classification, it would be expected to replace the other active patient statuses with a continuous scale. Patients with higher MELD scores are at greater risk of short-term death without a transplant and will receive higher priority.

Dr. Adams noted that the board may authorize the new policy to take effect on a voluntary basis prior to final government approval. "We want to emphasize the priority of developing this policy as expeditiously as possible because the evidence suggests it will save lives," said Dr. Adams.

The proposal will prioritize patients much more precisely by medical urgency and provide for a transition to ensure that those most in need would have the greatest priority for donated livers.

The United Network for Organ Sharing (UNOS), a nonprofit charitable organization, maintains the nation's organ transplant waiting list under contract with the U.S. Department of Health and Human Services' Health Resources and Services Administration. Under that contract and on behalf of the Organ Procurement and Transplantation Network (OPTN), UNOS brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy.