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Expand Required Simultaneous Liver-Kidney Allocation

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Current policy

Organ Procurement Organizations (OPOs) are required to make Simultaneous Liver-Kidney (SLK) offers to eligible candidates within 250 Nautical Miles (NM) from the donor hospital. After making the required SLK offers, OPOs are then able to decide for themselves if they want to continue offering the SLK to eligible candidates beyond 250 NM. To provide clarity and better direction to OPOs, the committee is proposing that SLK offers be required for all eligible candidates within 500 NM of the donor hospital. The 500 NM requirement would also align with other multi-organ allocation policies, which would help eliminate confusion in the allocation process.

Supporting media


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Proposed changes

  • Require SLK allocation out to 500 nautical miles for Status 1A or 1B candidates and candidates with a MELD of 29 or greater.
  • Clarify allocation policy for Organ Procurement Organizations (OPOs) by stating that OPOs can offer the liver and kidney according to other policies after making all required SLK offers.
  • Make small changes to SLK policy to provide clarity and better align with other multi-organ allocation policies:
    • Clarify that any mention of MELD refers to a candidate’s allocation MELD score
    • Align SLK policy language with the policy language for heart-kidney, lung-kidney, heart-liver, and lung-liver allocation
    • Remove references for PELD score from SLK policy, since OPOs are required to share both organs with all pediatric candidates listed for SLK, regardless of their PELD score
    • Move pediatric SLK allocation policy ahead of adult SLK eligibility requirements since pediatric SLK candidates do not have to meet eligibility requirements like adult SLK candidates

Anticipated impact

  • What it's expected to do
    • Improve access to transplant for SLK candidates
    • Help minimize confusion around SLK allocation policies
    • Align the distance for required shares in SLK policy with Simultaneous Heart-Kidney (SHK) policy
    • Promote more equal acces to transplant between SLK and SHK candidates
  • What it won't do
    • The proposal is not expected to significantly decrease access to transplant for kidney-pancreas and kidney-alone candidates since many OPOs are already offering SLKs to candidates within 500 NM

Terms to know

  • Simultaneous liver-kidney (SLK): transplanting both a liver and kidney from the same deceased donor into one recipient.
  • Simultaneous heart-kidney (SHK): transplanting both a heart and kidney from the same deceased donor into one recipient.
  • MELD: Model for End Stage Liver Disease. The scoring system used to measure illness severity in the allocation of livers to adult candidates.
  • PELD: Pediatric End Stage Liver Disease. The scoring system used to measure illness in the allocation of livers to pediatric candidates.
  • Nautical Mile (NM): A unit of measurement roughly equal to 1.15 miles, it is based on the Earth’s coordinates of longitude and latitude.

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Read the full proposal

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