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Review of Liver and Intestines Variances in OPTN Policy

eye iconAt a glance

Current policy

There are four variances related to the allocation of livers and intestines in OPTN policy.  Each of the variances is time limited and has a different expiration date.  The OPTN Liver and Intestinal Organ Transplantation Committee wants to align the expiration dates of the four variances to expire when continuous distribution for livers and intestines begins.

Supporting media

Presentation

View presentation

Proposed changes

  • Align expiration dates for all liver variances

Anticipated impact

  • What it’s expected to do
    • Allow more consistent evaluation and management of liver and intestine variances
    • Allow the Committee to consider which aspects of the four variances should be incorporatated into permanent OPTN policy
  • What it won’t do
    • Will not change how the variances apply to the current allocation of livers and intestines in OPTN policy

Terms to know

  • Variance: Time limited experimental polices that test potential changes that will improve allocation by more effectively addressing fairness, utility, efficiency, need and/or supply
  • Open Variance: A variance that allows members other than the members that applied for the variance to join
  • Closed Variance: A variance that does not allow other OPTN members to join

Click here to search the OPTN glossary

eye iconComments

UC San Diego Health Center for Transplantation | 09/29/2022

The UC San Diego Health Center for Transplantation (CASD) appreciates the opportunity to provide public comment on the proposal to Review of Liver and Intestines Variances in OPTN Policy. CASD agrees that this makes sense administratively and have no concerns, assuming that the Committee retains the right to bring forward additional proposals to modify if necessary, dependent on the development timeline for the liver continuous distribution policy.

Attachment

Region 6 | 09/28/2022

Sentiment: 4 strongly support, 14 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose

Region 10 | 09/28/2022

Sentiment: 2 strongly support, 10 support, 4 neutral/abstain, 0 oppose, 0 strongly oppose

NATCO | 09/28/2022

NATCO thanks the Liver and Intestinal Organ Transplantation Committee for its efforts to align expiration dates for all liver variances. NATCO supports this proposal to align the expiration dates of the four variances in OPTN policy to expire upon implementation of continuous distribution of livers and intestines. NATCO also supports the further development of whether, and how, to include the variances in the new allocation framework.

Region 8 | 09/27/2022

Sentiment: 0 strongly support, 13 support, 6 neutral/abstain, 0 oppose, 0 strongly oppose

Region 7 | 09/27/2022

Sentiment: 1 strongly support, 11 support, 2 neutral/abstain, 0 oppose, 0 strongly oppose | This was not discussed during the meeting, but OPTN representatives were able to submit comments with their sentiment. There was noted support for extending the dates of the four variances until they are incorporated into the continuous distribution framework

American Society of Transplantation | 09/27/2022

The American Society of Transplantation generally supports the changes included in the proposal, “Review of Liver and Intestines Variances in OPTN Policy.”

Attachment

Region 11 | 09/26/2022

Sentiment: 5 strongly support, 10 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose Comments: An attendee recommended that split liver allocation should be promoted and recommended that the Region 8 variance be extended across the country.

American Society of Transplant Surgeons | 09/26/2022

The American Society of Transplant Surgeons (ASTS) is pleased to provide the following feedback to the OPTN Liver and Intestinal Organ Transplantation Committee. Does the community support aligning the expiration dates for the four liver variances in OPTN policy to expire upon implementation of continuous distribution of livers and intestines? ASTS supports this proposal as written and aligning the end dates so the variances close when continuous distribution goes into effect, with the caveat that there is implementation of continuous distribution in a reasonable time period in the future.

Attachment

Region 1 | 09/21/2022

Sentiment: 1 strongly support, 6 support, 3 neutral/abstain, 0 oppose, 0 strongly oppose

Region 3 | 09/20/2022

Sentiment: 1 strongly support, 8 support, 6 neutral/abstain, 0 oppose, 0 strongly oppose | Comments: This was not discussed during the meeting, but OPTN representatives were able to submit comments with their sentiment. It was noted that multiverseral allocation needs to be addressed by the system and LifeLink of Puerto Rico will continue to need a variance.

Region 2 | 09/13/2022

Sentiment: 5 strongly support, 13 support, 6 neutral/abstain, 0 oppose, 0 strongly oppose

Region 9 | 09/12/2022

Sentiment: 0 strongly support, 7 support, 2 neutral/abstain, 0 oppose, 0 strongly oppose

Region 5 | 09/08/2022

Sentiment: 11 strongly support, 15 support, 5 neutral/abstain, 0 oppose, 1 strongly oppose | Comments: A member commented that he supports discontinuing ineffective variances that haven’t worked as intended.

Region 4 | 08/26/2022

Sentiment: 0 strongly support, 16 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose

Anonymous | 08/16/2022

Some of the information on line is confusing. I know that Cleveland Clinic does laparoscopic surgery for living donor liver transplants on the donor. Are they the only center? Why aren’t other centers moving that way? I remember more centers at one time were performing liver donor transplants but moved away from that procedure after a few problems. Why aren’t they moving back into this area? How can you be compensated but getting new complications? I see some items occurring in our communities that will increase the need for multiple organs. Who tracks these and takes action? One is an old polybutylene piping used widely in 1980’s until 1995 when a billion dollar class action suit was settled with Shell and Dupont. Was the money used to remove the pipes-NO. The EPA measures iron in the water but does not control it. This is especially dangerous if you have a tendency to overload. Some states like Arkansas tried to reopen a few years ago because the pipes are failing-14 million out there. Moving on-mitochondria mutations cause organ damage. These diseases don’t fit into MELD and doctors aren’t doing exceptions. Most doctors have no understanding of mito-ask any doctor the difference between mito and nuclear or how many complexes exist.