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MELD exception scores during NLRB transition

Proposal Overview

The comment period for this proposal is now closed.

Sponsoring Committee: Executive

Strategic Goal: Provide equity in access to transplants

Read the full proposal (PDF; 1/2019)

Read NLRB conversion mini brief (PDF; 4/2019)

Read NLRB conversion policy notice (PDF; 4/2019)

Contact: Elizabeth Miller

Executive Summary

Liver allocation currently uses Donation Service Areas (DSAs) and OPTN regions as units of distribution. That will change when recently approved allocation changes are implemented (targeted for April 30, 2019). The National Liver Review Board (NLRB) was to be implemented on January 31, 2019, but that plan was delayed because unintended consequences were identified in the plan to base the model for end stage liver disease (MELD) exception scores on median MELD at transplant within 250 NM of the transplant hospital (MMaT/250). Because the MMaT/250 for transplant programs within the same DSA can vary, similarly situated candidates at different hospitals within a DSA can have different scores, and would consistently appear lower or higher than one another on every match run while allocation is still based on DSA and region. The OPTN is now soliciting comments on a policy change that would apply only with respect to the calculation of exception scores to address this issue. This transition policy would be in effect for a brief period after the public comment period (scheduled to end March 22, 2019) and before implementation of the revised allocation policy (targeted for April 30, 2019).

In an attempt to address this situation, the OPTN Executive Committee approved the OPTN Liver Committee’s proposed temporary solution: using the median MELD at transplant in the DSA (MMaT/DSA) instead of MMaT/250 during the period between implementation of the NLRB and implementation of liver allocation changes (hereafter, “transition period”). This transition period will be interim, and will expire upon the implementation of liver allocation changes (targeted for April 30, 2019). The goal of this approach is to better align the calculation of exception scores with the current allocation system during the transition period.

Feedback requested

The Committee requests feedback on the proposed temporary solution of using the MMaT/DSA instead of MMaT/250 during the transition period. In addition to feedback on the proposed solution, the Committee welcomes comment on the other options considered by the committee as well as whether to convert exception scores that were granted by Regional Review Boards (RRB) but will expire after the implementation of the new allocation system (see pages 5-6). The Executive Committee may reconsider these alternate solutions for this proposal.