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Liver distribution policy proposal to advance for August public comment

Published on: Wednesday, April 27, 2016

Rosemont, Ill. - The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee, at its meeting April 27, agreed on a proposal to be shared with the public for input in order to improve liver distribution nationwide. The proposal, to be published for public comment in August 2016, is intended to increase consistency in medical urgency scores at transplant for candidates in various areas of the country.

“Our recommendations reflect a lengthy, collaborative discussion throughout the donation and transplantation community to improve transplant equity,” said Ryutaro Hirose, M.D., chair of the committee. “Through our public comment process, we encourage anyone with an interest and perspective on these issues to voice their thoughts, comments and questions. We fully expect a final proposal may be modified and improved as a result of public feedback.”

The committee has discussed various concepts for improving liver distribution for more than two years. Earlier milestones include publication of an initial concept document in June 2014 and hosting of two public forums to seek input regarding potential policy options and the implications of wider distribution.

A number of alternative options have been statistically modeled to estimate their possible effects on key measures of effectiveness. “Many options our committee studied would create more equity in liver distribution in key respects,” said Dr. Hirose, “such as reducing the number of candidates who die awaiting a transplant and reducing the geographic variation in how sick a candidate must be before being likely to get a transplant.”

The concept approved by the committee would not change the current MELD or PELD allocation formulas used to determine the level of medical urgency of liver candidates. It would, however, alter the long-established geographic sequence used to prioritize candidates based on the donor’s location. It would create eight liver allocation districts nationwide, with district-wide distribution of livers for candidates in the most urgent medical condition (those with a MELD/PELD score of 29 or higher) before local matching of less sick candidates. In an effort to promote the efficient management of organ placement and promote patient access to transplantation, candidates listed at hospitals within the district and within 150 miles of the donor’s location would receive three additional allocation points.

In parallel to the public comment process, the committee will review additional statistical modeling to review the effect of the proposed policy at different thresholds of MELD/PELD scores. A separate, future public comment item will propose the establishment of a national liver review board to determine MELD/PELD exception scores as a potential replacement of the current 11 regional review boards.

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 United Network for Organ Sharing (UNOS). The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.