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​​National Liver Review Board (NLRB) Updates Related to Transplant Oncology​

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Current policy

When a liver transplant program believes that a candidate’s calculated model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score does not accurately reflect their medical urgency for transplant, they can submit a request for a MELD or PELD exception score. The National Liver Review Board (NLRB) reviews requests from transplant programs for these exception scores. The NLRB has three specialty Review Boards: Pediatric, Adult Hepatocellular Carcinoma and Adult Other Diagnosis. The NLRB uses OPTN policy and guidance documents to decide whether to approve or deny exception score requests. The OPTN Liver and Intestinal Organ Transplantation Committee regularly evaluates the NLRB guidance to identify opportunities for improvement.

Supporting media

View presentation PDF link

Proposed changes

  • Guidance for non-standard exception requests will be added for two diagnosis: colorectal liver metastases and intrahepatic cholangiocarcinoma
  • Expands the purview of the current Adult Hepatocellular Carcinoma (HCC) Review Board who review non-standard HCC cases to also review non-standard exception cases related to liver cancers and tumors
    • The current Adult HCC Review Board and guidance document scope is broadened and will be renamed as the Adult Transplant Oncology review board and guidance document
  • Clarify existing policy 9.5.A to align the policy language for Committee review and approval of hilar cholangiocarcinoma (CCA) patient care protocols to current practice and original intent

Anticipated impact

  • What it's expected to do
    • Provide NLRB reviewers and transplant programs with new guidance for reviewing MELD exception requests for candidates with colorectal liver metastases or intrahepatic cholangiocarcinoma
    • Ensure that the appropriate reviewers with expertise are reviewing these cases by broadening the current Adult HCC Review Board to become an Adult Transplant Oncology Review Board
    • Clarify policy to align the policy language to current practice and original intent.
    • Creates a more efficient and equitable system for reviewing MELD and PELD exception requests
  • What it won't do
    • Will not cause any candidates to lose an exception
    • Will not impact pediatric candidates
    • Will not change the review process for the Adult Transplant Oncology Review Board

Terms to know

  • Guidance Documents: Documents that provide information to transplant programs and NLRB members to use when making decisions on exception requests.
  • Model for End-Stage Liver Disease (MELD): The scoring system used in allocation of livers to candidates who are at least 12-years old.
  • Pediatric End-Stage Liver Disease (PELD): The scoring system used in allocation of livers to candidates who are under 12-years old.
  • National Liver Review Board (NLRB): A review board of OPTN members drawn from a nationwide pool of liver transplant physicians and surgeons, who review exception requests from transplant programs for candidates whose automatically calculated model for end-stage liver disease (MELD) score or pediatric end-stage liver disease (PELD) score does not accurately reflect the candidate’s medical urgency for transplant.
  • Match Run: A computerized ranking of transplant candidates based upon donor and candidate medical compatibility and criteria defined in OPTN policies.

Click here to search the OPTN glossary


Read the full proposal (PDF)

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