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System notice: Access for urgent liver candidates in Hawaii and Puerto Rico implemented Feb. 18

Published on: Monday, February 17, 2020


Liver and intestine transplant program directors, surgeons, physicians, administrators, clinical coordinators, data coordinators and clinical support staff; OPO executive directors and procurement directors/managers; compliance and quality managers

Implementation date: February 18, 2020


On Tuesday, Feb. 18, a variance was implemented to improve timely access to donors for liver candidates listed as Status 1A, Status 1B, or with a MELD or PELD score of 37 or higher in Hawaii and Puerto Rico. It establishes additional geographic units of 1,100 nautical miles for candidates listed in Puerto Rico and 2,400 nautical miles for candidates listed in Hawaii. Details of the policy are contained in this policy notice.

Implementation details

These additional distribution units only apply for candidates listed in Hawaii or Puerto Rico who are in urgent need of a liver transplant.  The additional classification follows other distribution sequences in the acuity circle liver policy for urgent candidates listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital. The additional classifications does not apply to any candidates in Hawaii or Puerto Rico with a MELD or PELD score below 37.

The variance will be evaluated annually and will expire after five years. It may be more likely to affect OPOs in areas geographically closest to the transplant programs in Hawaii or Puerto Rico, although the overall number of candidates expected to be affected by the variance is anticipated to be low.

What you need to do

Match runs for liver and liver-intestine offers follow the updated sequence.  Continue to follow the match run process as usual.

Resources and education

Access policy and system training in UNOS Connect from the course catalog; Liver category

  • LIV101-D: Access for Urgent Liver Candidates in Hawaii and Puerto Rico

If you have questions relating to implementation, contact UNOS Customer Service at 800-978-4334.  For policy-related questions, send an e-mail to