Liver review board guidance

Updated February 2025

For liver transplant programs & NLRB

These resources are not OPTN Policy, so they do not carry the monitoring or enforcement implications of policy. They are not official guidelines for clinical practice, nor are they intended to be clinically prescriptive or to define a standard of care. These resources are intended to provide guidance to transplant programs and the National Liver Review Board (NLRB).

Adult MELD exception review

This document summarizes available evidence to assist clinical reviewers in approving candidates for adult MELD exceptions.

View adult MELD exception review guidance (updated 2/27/2025)

Pediatric MELD/PELD exception review

This document summarizes available evidence to assist clinical reviewers in approving pediatric candidates for status 1B exceptions and MELD or PELD exceptions.

View pediatric MELD/PELD exception review guidance (updated 7/13/2023)

Adult MELD exceptions for Transplant Oncology 

This document summarizes available evidence to assist clinical reviewers in approving candidates for adult MELD exceptions related to liver cancer and tumors

Adult Meld Exceptions for Transplant Oncology Review Guidance (PDF; 2/27/2025)