Richmond, Va. – The Board of Directors of the Organ Procurement and Transplantation Network, at its meeting June 27, unanimously approved a series of improvements to the medical urgency scores used to rank liver transplant candidates. The updated score for adult candidates will increase parity in access to liver transplant between sexes. It also updates diagnostic criteria within the formulas that assign priority for adults and children. United Network for Organ Sharing (UNOS) serves as the OPTN under federal contract.
“These actions will increase the equity of access to liver transplantation,” said Matthew Cooper, M.D., president of the board. “Recent research has noted a persistent difference in female candidates’ ability to access a transplant when compared to male candidates. This policy will increase female candidates’ opportunities and create better equivalency in the liver allocation system. The other changes are collectively designed to make the urgency scoring system more predictive of the needs of all candidates.”
Liver transplant candidates age 12 and older, when listed for a transplant, receive a medical urgency score called the Model for End-Stage Liver Disease (MELD). The Pediatric End-Stage Liver Disease (PELD) score is used for candidates younger than 12. Both are computed using objective medical tests or information known to affect a person’s short-term mortality risk without a liver transplant.
The approved actions will add a modifier to the MELD score for female candidates to make it easier for them to access transplantation. The updates also include the addition of an albumin variable to MELD and a creatinine variable to PELD. In addition, the approved policy updates the coefficients for the existing clinical variables to each score, as well as other adjustments to improve their ability to predict mortality risk.
Other related policy changes include updates to qualifying and sorting criteria for the two highest urgency statuses for liver transplant candidates, Status 1A and 1B. Only a small proportion of liver transplant candidates are in either status, but they are considered to be at the highest immediate risk of death without a transplant.
Other actions
The board took a number of additional actions as follows:
- Eliminated the use of race-based formulas for calculating kidney function for any OPTN purpose
- Approved the establishment of minimum criteria expected for OPTN members to perform a biopsy of a deceased donor kidney
- Endorsed new standards for reporting and data collection regarding donor kidney biopsies
- Approved modifications for living donor exclusion criteria
- Accepted updates to policy and guidance regarding the diagnoses of liver transplant candidates with MELD or PELD exceptions
- Approved criteria for eligibility and safety net priority for the allocation of combinations of heart-kidney and lung-kidney combinations recovered from the same donor, as well as corresponding data collection
- Accepted changes to the Calculated Panel Reactive Antibody (CPRA) formula
- Modified timing requirements for testing pediatric transplant candidates for HIV, hepatitis B and hepatitis C
- Accepted modifications to the definition of graft failure as it applies to vascularized composite allograft (VCA) transplantation
- Approved changes to data collection to align across categories of organ transplants
- Appointed three individuals (Robert Goodman, Barry Massa and Jeff Orlowski) to complete vacant terms on the board
- Endorsed revisions to the OPTN charter
- Approved the appointment of incoming OPTN committee chairs whose term begins July 1, 2022
- Approved a fiscal year 2023 budget and registration fee, subject to review by the U.S. Department of Health and Human Services
Discussion items
The board hosted additional discussion on the following initiatives:
- A presentation from the National Academies of Sciences, Engineering and Medicine (NASEM) regarding its recently published analysis of issues relating to transplant equity
- An update regarding study of how social determinants of health may affect organ transplantation
- A progress update regarding study of potential revisions to the OPTN regional structure
- A progress update on ongoing development of kidney and pancreas allocation policy based on continuous distribution
- A briefing from the OPTN Policy Oversight Committee on projects currently under review
- An update on a number of initiatives in progress to support OPTN strategic goals
- A briefing on work in progress to recruit and appoint volunteers to serve on the Board of Directors and committees
