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Update on Continuous Distribution of Livers and Intestines

eye iconAt a glance

Current policy

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 for various factors, such as medical urgency, candidate biology, patient access, and placement efficiency. Continuous distribution will remove the hard boundaries built into the current framework to increase equity for patients and transparency in the system.

This request for feedback builds upon the 2022 concept paper, provides an overview of the project’s development process and progress, and offers next steps for continuous distribution of livers and intestines. The paper also requests community feedback that will assist the Liver and Intestinal Organ Transplantation Committees’ work.

Click here for a closer look at Continuous Distribution

Click here for a closer look at Liver Continuous Distribution

Requested feedback — Liver Values prioritization exercise

  • The community is asked to participate in a liver values prioritization exercise. The liver values prioritization exercise, which uses an Analytical Hierarchy Process (AHP) methodology, will help the committee determine how to rank the various attributes used to develop a composite allocation score.

Participate in the liver values prioritization exercise

Supporting media

Watch Colleen Reed, PhD, MSW, a liver transplant recipient who serves on the OPTN Liver and Intestinal Organ Transplantation Committee, explain the continuous distribution framework and how patients, donors, and their families can provide feedback on the project.

Watch James Pomposelli, MD, PhD, chair of the OPTN Liver and Intestinal Organ Transplantation Committee provide an overview of the request for feedback on continuous distribution of livers and intestines and how to participate in the values prioritization exercise.

Additional feedback requested

  • The community is asked to provide feedback on the committee’s progress to date and the plan for moving the project forward
  • The committee is seeking feedback on the proposed list of attributes to be included in the first iteration of continuous distribution


View presentation

Anticipated impact

  • What it's expected to do
    • Provide a more equitable approach to matching candidates and donors
    • Remove hard boundaries 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 request for feedback is not a proposed policy change, but will help the Liver and Intestinal Organ Transplantation Committees develop a future policy proposal

Terms to know

  • Attribute: Criteria used to classify then sort and prioritize candidates. For example, in liver allocation, criteria include medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency.
  • Analytical Hierarchy Process (AHP): An exercise that asks participants to rate the importance of an attribute when it is compared to another attribute.
  • Composite Allocation Score: Combines points from multiple attributes together. This request for feedback proposes the use of composite allocation scores in a points-based framework.
  • Rating Scale: Describes how much preference is given to candidates within each attribute.
  • Weights: Reflect the relative importance or priority of each attribute toward the overall goal of organ allocation. 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

Read the full proposal

Provide feedback

eye iconComments

Anonymous | 02/02/2023

I agree with this.

Steven Weitzen | 01/29/2023

I support the initiative.