One-year monitoring report for updated liver urgency policy shows progress

Published on: Friday, March 21, 2025

An Organ Procurement and Transplantation Network (OPTN) data report shows progress in increasing access to liver transplants among adult male and female candidates, a key OPTN policy goal. The data report covers the first 12 months of the updated liver allocation policy, which aimed to improve candidate priority based on medical urgency scores.

Key observations, comparing 12 months of outcomes before and after the updates took effect, include the following:

For Model for End-Stage Liver Disease (MELD) candidates (aged 12 and older), both the number and rate of liver transplants increased after policy implementation. There were 8,267 deceased donor liver transplants in the pre-policy era among MELD recipients, increasing by 13 percent to 9,366 post-policy.
While transplant rates increased significantly post-policy for both male and female MELD candidates, the larger increase for female candidates resulted in no statistically significant difference in transplant rates for males and females post-policy. In addition, while the median MELD score at transplant remained unchanged at 27 for male recipients, the median score dropped among females from 29 to 28.
There were no statistically significant changes in the rate of MELD candidates removed from the waiting list due to death or being too sick to transplant.
Transplant rates for MELD candidates increased for all groups based on height and body surface area (BSA); the changes were statistically significant for all except the smallest height group.
For Pediatric End-Stage Liver Disease model (PELD) candidates (aged 11 years and younger), there were no statistically significant changes either in transplant rate or the rate of waiting list removal due to death or being too sick to transplant. However, the median PELD score at transplant decreased, from 33 pre-policy to 31 post-policy. In addition, the degree of variation decreased in the range of PELD scores at transplant.
The number of pediatric Status 1A and 1B liver transplants increased from the pre-policy to post-policy era.
The number of pediatric Status 1B cases that qualified by exception (meaning they did not meet standard qualification criteria) decreased from the pre-policy to post-policy timeframe, as did the number of exception applications that were not approved.

The OPTN Liver and Intestinal Organ Transplantation Committee will continue to monitor policy effects, with the next planned report for the two-year period after policy implementation.