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New national liver transplant system takes effect

The OPTN launched a new liver distribution system on May 14 as part of an effort to update and improve the organ sharing system responsible for saving tens of thousands of lives each year. This new policy will save more lives annually, with fewer patients dying while waiting for a liver transplant. It also is expected to increase the number of pediatric liver transplants, making this a national policy that will work more efficiently and fairly for patients across the entire country.

Adopted by the OPTN Board of Directors in December 2018, the liver distribution policy re-calibrates how geography is considered when matching donated livers with transplant recipients based on experience gained with the previous, decades-old system that heavily relied on geographic boundaries of 58 donor service areas (DSAs) and 11 transplant regions. The new system emphasizes the medical urgency of liver transplant candidates and the distance between the donor hospital and transplant hospitals. The transplant community, including a committee comprising transplant experts, organ recipients, and donor families from around the country and the OPTN Board of Directors—with extensive input from the public—came together to develop and approve this new liver policy.

Livers from all deceased donors will first be offered to the most urgent liver transplant candidates (Status 1A and 1B) listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital. Livers from adult donors would next be offered to candidates at hospitals within distances of 150, 250 and 500 nautical miles of the donor hospital. These offers are grouped by medical urgency. Candidates at hospitals within 150 nautical miles are prioritized unless there are other candidates at considerably higher medical urgency farther away.

Statistical modeling of the new system projects that it will decrease waiting list deaths due to increased prioritization of highly urgent liver candidates. The new policy is also projected to increase pediatric transplants by increasing priority for pediatric candidates relative to adults when the donor is younger than age 18.

Also on May 14, the OPTN implemented a National Liver Review Board (NLRB) to replace the regional review process previously used to consider exception scores for liver candidates whose calculated MELD or PELD score does not reflect their medical urgency. The new process promotes equity by creating greater consistency in the review and application of exception scores for candidates nationwide. This article describes the NLRB.

Information about how the new system was developed is available in the liver distribution section of the OPTN website.  Transplant professionals, as well as transplant candidates and their families, can learn more details about the policy implementation in an implementation toolkit.