Skip to main content

Continuous Distribution of Livers and Intestines Concept Paper

eye iconAt a glance

Background

In December 2018, the OPTN Board of Directors approved the continuous distribution framework for allocation of all organs. Continuous distribution will rank waiting list candidates based on points related to various factors, such as medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency. Continuous distribution will remove the boundaries between classifications and will increase equity for candidates and transparency in the system.

This concept paper provides an overview of the project’s development, progress to date, and next steps for continuous distribution of liver and intestines. The paper requests community feedback that will assist the Liver and Intestinal Organ Transplantation Committee’s work.

Supporting media

Presentation

View presentation

Progress

  • From December 2021 to present, the Liver and Intestinal Organ Transplantation Committee worked to identify which attributes should be included in the future allocation system.

Proposed concept

  • Continuous distribution will replace the current classification-based allocation system with a points-based framework. This points-based system will assign a composite allocation score to each candidate.
  • A candidate’s composite allocation score will determine the order that organs are offered to candidates.
  • A candidate’s composite allocation score will consider a combination of donor and candidate characteristics including candidate medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency.

Anticipated impact

  • What it's expected to do
    • Provide a more equitable approach to matching candidates and donors
    • Remove hard boundaries between classifications that prevent candidates from being prioritized higher on the match run
    • Establish a system that is flexible enough to work for each organ type
  • What it won't do
    • This paper is not a proposed policy change, but will help the Liver and Intestinal Organ Transplantation Committee develop a future policy proposal.

Terms to know

  • Attribute: Attributes are criteria we use to classify then sort and prioritize candidates. For example, in liver allocation, criteria include model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score, blood type compatibility, distance between donor hospital and transplant program, and others.
  • Composite Allocation Score: A composite allocation score combines points from multiple attributes together. This concept paper proposes the use of composite allocation scores in a points-based framework.
  • Rating Scale: A rating scale describes how much preference is given to candidates within each attribute.
  • Weights: Weights reflect the relative importance or priority of each attribute in the overall composite allocation score. Combined with the ratings scale and each candidate’s information, this results in an overall composite score for prioritizing candidates.

Click here to search the OPTN glossary

Provide feedback

eye iconComments

Harvey Solomon | 08/11/2022

I suggest that the committee consider including in the design of concept DRI, historic acceptance of accepting transplant center and ability to backup offer in the immediate vicinity if declined.