National Liver Review Board implementation postponed

Published on: Tuesday, February 5, 2019

Important note: Liver distribution policy and NLRB implementation are deferred until May 14. 

The National Liver Review Board (NLRB) implementation, originally scheduled for January 31, 2019, is postponed.  Unintended consequences were identified in the plan to base the model for end stage liver disease (MELD) exception scores on median MELD at transplant during the transitional period between NLRB implementation and implementation of the liver distribution system, which is planned for April 30, 2019. 

The OPTN/UNOS Executive Committee voted January 30 to seek public comment on implementation of a median MELD at transplant (MMaT) score calculated on the basis of the donation service area (DSA) in which the liver transplant center is located.  This proposed alternative may replace, on an interim basis, the MMaT calculation based on transplants performed at hospitals within a 250 nautical mile radius of the hospital where the exception candidate is listed. 

This proposed interim approach would only be used for the period of time between NLRB implementation and the liver distribution system based on acuity circles.  The April 30 target implementation date for the liver distribution system has not changed.

The current regional review board (RRB) system will continue to function until NLRB implementation, which will be set at a future date, to be determined after consideration of the public comments. 

NRLB resource and educational materials will be updated as appropriate to reflect these changes.  Look for additional updates as they become available.