Liver timeline
Increasing equity in liver transplants
Timeline
The following timeline shows the major milestones in liver allocation and distribution policy development. Scroll to the bottom of the page for a text version of the timeline.
First liver policy developed
1987Institute of Medicine allocation recommendations
1999HRSA releases OPTN Final Rule
2000Objective measure of medical urgency replaces point system
2002Regional sharing for candidates with MELD scores of 15 or greater
2005Regional Sharing for Status 1 candidates
2010HHS Advisory Committee on Transplantation recommendations
2012OPTN Strategic Plan – reduce geographic disparities
2012Board directs organ-specific committees to define measure of fairness
2012Revised policy broadening regional and national access for highly urgent liver candidates
2013Liver Redistricting Concept Paper
2014Public Forum on Liver Redistricting in Chicago
20142nd Public Forum on Liver redistricting in Chicago
2015Revised policy for liver candidates with exception scores for hepatocellular carcinoma (HCC)
2015Additional element added to medical urgency calculation
2016Initial public comment proposal
2016Second public comment proposal
2017Text version of liver timeline
1987
- First liver policy developed
Livers were allocated through a point system assigning relative weights for medical urgency, blood group, compatibility, logistic considerations and waiting time to patients within distinct distribution units.
1999
- Institute of Medicine allocation recommendations
IOM recommended establishment of liver allocation areas broad enough to provide for medically effective distribution of organs.
2000
- HRSA releases OPTN Final Rule
"Neither place of residence nor place of listing shall be a major determinant of access to a transplant."
2002
- Objective measure of medical urgency replaces point system
MELD/PELD score replaces statuses with a more objective way of measuring medical urgency. This change results in better transplant outcomes despite sickest first triage, and lower waitlist mortality.
2005
- Regional sharing for candidates with MELD scores of 15 or greater
Candidates with higher medical urgency (MELD/PELD of 15 or higher) are offered livers throughout the region before local, less urgent candidates.
2010
- Regional Sharing for Status 1 candidates
Results in waitlist mortality reduction for status 1 recipients, especially pediatric recipients.
2012
- HHS Advisory Committee on Transplantation recommendations
Recommended that organ allocation should be evidence-based and not based on the arbitrary boundaries of OPOs or their DSAs. HRSA supports effective approaches to develop distribution systems that minimize this variation. - OPTN Strategic Plan – reduce geographic disparities
Board adopted a strategic plan that included reducing geographic disparities in access to transplantation. - Board directs organ-specific committees to define measure of fairness
Board agreed that observed geographic disparities in access to organ offers were unacceptably high and charges organ-specific committees to develop policy to minimize effects of geography.
2013
- Revised policy broadens regional & national access for highly urgent liver candidates
Decreased wait time, increased access and decreased waitlist mortality for candidates with a MELD of 35 or higher.
2014
- Liver Redistricting Concept Paper
The Liver Committee released a concept paper and questionnaire seeking public input on distributing livers over wider districts instead of traditional regions. - Public Forum on Liver Redistricting in Chicago
The Liver Committee held a public forum to seek additional input regarding liver redistricting concepts. Workgroups were formed to study issues relating to potential redistricting.
2015
- 2nd public forum on liver redistricting in Chicago
Workgroup findings and modeling results were presented; additional modeling was requested to study potential impact of distribution within concentric circles surrounding donor hospital. - Revised policy for liver candidates with exception scores for hepatocellular carcinoma (HCC)
Capped HCC exception points at 34 and added a 6 month delay before HCC points are initially awarded.
2016
- Additional element added to medical urgency calculation
Helps patients whose MELD will increase by adding serum sodium as an additional factor. - Initial public comment proposal
The Liver Committee sought public feedback on a proposal to establish new districts for liver distribution. Based on public feedback, the committee chose to investigate other options for a future proposal.
2017
- Enhanced liver distribution policy approved
The revised policy will offer more transplant access to candidates at a greater medical priority level who are local to the donor hospital, whether they are inside or outside current regional boundaries. - National Liver Review Board approved
The national board will replace the individual review boards in each of the 11 OPTN regions, creating greater consistency in assigning exception scores for medical conditions not assessed reliably by MELD or PELD scores.