Organ Procurement and Transplantation Network

Implementation toolkit

A federal court considering a legal challenge to the liver and intestinal organ allocation policy based on acuity circles has determined, in a ruling issued Jan. 16, 2020, not to issue an injunction on policy implementation. As a result, the OPTN plans to implement the policy on Feb. 4, 2020, to allow for computer programming and notification of members.

News

• Pre-implementation notice: Liver and intestinal organ distribution based on acuity circles to be implemented Feb. 4, 2020 (1/20/20)
• Updated liver and intestinal organ allocation policy to be 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)
• Median MELD and PELD scores at transplant updated; will be used in exception score assignment effective Sept. 24, 2019 (9/9/2019)
• 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 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 

• 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)
• Liver variance list (PDF; 9/2019)
• Median MELD at Transplant by DSA (PDF; effective 9/24/2019)
• Median MELD at Transplant by circles reference (PDF; 9/2019)
• NLRB six-week report (PDF; 7/2019)
• NLRB operational guidelines (PDF; 1/2019)
• Questions and answers for patients about liver allocation
• NLRB patient FAQ (PDF; 6/2019)

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)
• Liver review board guidance (6/2017)
• Increasing utilization of deceased donor livers (PDF - 2.5 M; 6/2012)