OPTN/UNOS Board approves updated liver distribution system
Published on: Tuesday, December 4, 2018
Dallas – The OPTN/UNOS Board of Directors, at its meeting December 3, approved a new liver distribution policy to establish greater consistency in the geographic areas used to match liver transplant candidates with available organs from deceased donors and reduce geographic differences in liver transplant access.
“The Board carefully weighed a number of options, with the ultimate goals of best honoring the gift of organ donation and helping those in greatest need,” said Sue Dunn, president of the board. “This model represents a necessary step forward to address long-existing differences in transplant in various areas of the country.”
The 42-member board represents transplant clinical and professional disciplines throughout the United States, as well as views of transplant candidates and recipients, their family members, family members of deceased donors and living donors. “As a donor mom, I’m proud of the board’s decision to pass the new liver policy,” said Deanna Santana, the board’s vice president for patient and donor affairs. “When my family was approached about donation when my son died, my only thought was that I wanted to spare other families the heartache we were experiencing. This policy has the potential to better assure liver candidates are transplanted in a similar way around the country.”
The policy will replace fixed, irregular local and regional geographic boundaries historically used to match liver candidates based on the donor location. It initially prioritizes liver offers from most deceased adult donors in the following sequence:
- candidates with highest medical urgency (Status 1A and 1B) listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital
- candidates with a MELD or PELD score of 37 or higher listed at transplant hospitals within a radius of 150 nautical miles from the donor hospital
- candidates with a MELD or PELD score of 37 or higher listed at transplant hospitals within a radius of 250 nautical miles from the donor hospital
- candidates with a MELD or PELD score of 37 or higher listed at transplant hospitals within a radius of 500 nautical miles from the donor hospital
- a similar, continuing sequence of progressive offers (candidates at transplant hospitals within 150, 250 and 500 nautical miles of the donor hospital) for candidates with ranges of MELD or PELD scores from 33 to 36, from 29 to 32, and from 15 to 28
Livers from deceased donors older than age 70, and/or those who die as a result of cardiorespiratory failure, will be distributed differently. After consideration of Status 1A and 1B candidates within a 500 nautical mile radius of the donor hospital, they will next be offered to candidates with a MELD or PELD score of 15 or higher at transplant hospitals within 150 miles of the donor location. Most of these organs are accepted for local candidates, since they are most viable when the preservation time between recovery and transplantation is short.
In addition, livers from deceased donors younger than age 18 will first be offered to any pediatric candidates (younger than age 18) listed at any transplant hospital within a 500 nautical-mile radius of the donor hospital. This will give additional priority to pediatric transplant candidates compared to the current distribution system.
Simulation modeling of the approved system indicates it will reduce variation in transplants by MELD score that exist in various areas of the country under the current liver distribution system. Modeling further suggests it will reduce pre-transplant deaths and increase access for liver transplant candidates younger than age 18.