Organ Procurement and Transplantation Network

Implementation toolkit

News

• Updated Median MELD at Transplant scores take effect September 29 (9/17/2021)
• Updated monitoring report available for liver, intestine policy (9/15/2021)
• Updated 12-month monitoring report available for National Liver Review Board (5/12/2021)
• New policy establishes expedited placement of livers (3/25/2021)
• Updated 9-month monitoring report available for liver policy (1/15/2020)
• Two-month monitoring report available for acuity circles liver distribution (5/26/2020)
• Median MELD and PELD at transplant scores to be updated March 25 (3/9/2020)
• New national liver and intestinal organ transplant system in effect (2/4/2020)
• Updated liver and intestinal organ allocation policy implemented Feb. 4, 2020 (1/18/2020) 
• Public comment sought; Liver access for urgent candidates in Hawaii and Puerto Rico (11/28/2019)
• Report studies first 12 weeks of NLRB activity (10/21/2019)
• Public comment sought on split liver variance (10/8/2019)
• Educational webinar addresses NLRB process (10/1/2019)
• Assessing liver transplant candidates' level of illness (8/21/2019)
• NLRB update: Median MELD at Transplant now based on transplant hospital DSA (5/24/2019) 
• Liver allocation policy reverted to DSA and regions (5/23/2019)
• Pre-implementation notice: OPTN liver allocation policy to revert to DSA and regions May 23, 2019 (5/20/2019)
• Work in progress to revert to DSA-based system due to court order (5/20/2019)
• National liver review board is implemented (5/14/2019)
• New national liver transplant system takes effect (5/14/2019)
• Liver distribution policy, national liver review board, deferred until May 14 (4/23/2019)
• Board approves updated liver distribution system (12/2018)

Webinar recordings

• NLRB educational webinar (2/2020)
• NLRB update (10/2019)
  • NLRB webinar presentation (PDF; 10/2019)
• NLRB for members (4/2019)
• NLRB for review board members (4/2019)

Policy changes

• NLRB- and liver distribution-related policy notices

Documents 

• Updated monitoring report available for liver, intestine policy (9/2021)
• Median MELD at Transplant by 250 Nautical Mile Circles Around Liver Transplant Programs and Median PELD at Transplant Within the Nation (10/2021)
• MTS comparison (10/2021)
• National Liver Review Board Post-Acuity Implementation Report, One Year Data (PDF; 04/2021)
• One-Year Monitoring Report of Liver and Intestine Acuity Circle Allocation Removal of DSA and Region as Units of Allocation (PDF; 04/2021)
• Median MELD at Transplant by 250 Nautical Mile Circles Around Liver Transplant Programs and Median PELD at Transplant Within the Nation (PDF; 03/2021)
• Liver & Intestine Acuity Circle Allocation Out-of-the-Gate Report, Nine month report - Removal of DSA and Region as Units of Allocation (PDF; 12/2020)
• Liver & Intestine Acuity Circle Allocation Out-of-the-Gate Report, Six month report - Removal of DSA and Region as Units of Allocation (PDF; 10/2020)
• Median MELD at Transplant by 250 Nautical Mile Circles Around Liver Transplant Programs and Median PELD at Transplant Within the Nation (PDF; 9/2020)
• National Liver Review Board Post-Acuity Implementation Report, Three Month Data (PDF; 7/2020)
• Liver & Intestine Acuity Circle Allocation Out-of-the-Gate Report, Three Month Data (PDF; 7/2020)
• Liver & Intestine Acuity Circle Allocation Out-of-the-Gate Report, Two Month Data (PDF; 5/2020)
• Liver & Intestine Acuity Circle Allocation Out-of-the-Gate Report, One Month Data (PDF; 3/2020)
• Liver & Intestine Acuity Circle Allocation Out-of-the-Gate Report, One Month Data – Additional DSA Stratifications (PDF; 3/2020)
• Median MELD at Transplant by circles reference effective March 25, 2020 (PDF; 3/9/2020)
• Liver variance list (PDF; 3/2020)
• Acuity Circles FAQ (PDF; 2/2020)
• National Liver Review Board Out-of-the-Gate Report, Four Months Data Report (PDF; 10/2019)
• National Liver Review Board Out-of-the-Gate Report - Appendix (PDF; 10/2019)
• NLRB six-week report (PDF; 7/2019)
• Questions and answers for patients about liver allocation
• NLRB patient FAQ (PDF; 6/2019)
• View proposed liver allocation distribution dashboard 

Allocation calculators

The Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD) calculators are numerical scales used for liver allocation.

• MELD calculator (ages 12 and older)
• PELD calculator (under age 12)

Current policy & guidance

• OPTN Policy 9: Allocation of livers and liver-intestines (PDF - 2.5 MB)
• Evaluation plan guidance for policy 9 (PDF - 91 K)
• Liver review board guidance (Updated July 2021)
• Increasing utilization of deceased donor livers (PDF - 2.5 M; 6/2012)