On October 21, 2021, UNOS made a number of changes to the data collection and business rules on liver Status 1A and 1B justification forms to align with requirements defined in OPTN policies 9.1.A, 9.1.B, and 9.1C. This action stems from a review of the adult and pediatric liver Status 1A and 1B justification forms as a part of our ongoing organ allocation quality assurance efforts.
The changes are as follows:
Adult Liver Status 1A Justification Form:
- Anhepatic is now listed as a primary criterion on adult liver Status 1A justification forms. Since anhepatic is listed as primary criterion, it will no longer appear in the data collection under the primary non-function (PNF) or hepatic artery thrombosis (HAT).
- The form allows users to enter either an arterial or venous pH value for candidates with PNF or HAT. The form also allows users to report arterial and venous pH values to two decimal places. Arterial or venous pH values will be one of several criteria used to determine whether a candidate meets adult liver Status 1A requirements for PNF and HAT as defined in Policy 9.1.A.
- The form no longer allows users to specify segmental or whole graft for candidates with HAT, and the form will only automatically approve the candidate if aspartate aminotransferase (AST) is at least 3000 U/L and the candidate meets other qualifying criteria specified in Policy 9.1.A.
Pediatric Liver Status 1A Justification Form
- The form now allows users to enter either an arterial or venous pH value for candidates with primary graft nonfunction (PNF). The form also allows users to report arterial and venous pH values to two decimal places. Arterial or venous pH values are among the criteria used to determine whether a candidate meets pediatric liver Status 1A requirements for PNF as defined in Policy 9.1.B.
Pediatric Liver Status 1B Justification Form
- The liver Status 1B justification form will automatically approve a candidate for chronic liver disease with a Glasgow coma score (GCS) less than 10 if the candidate does not meet any other qualifying criteria, as defined in policy 9.1.C. The form no longer automatically approves a candidate for chronic liver disease with GCS equal to 10 if the candidate does not meet any other qualifying criteria.
Liver transplant programs should be familiar with the updates and, as necessary, be prepared to report additional information on the justification form.
UNetSM implements liver Status 1A and 1B requirements by collecting clinical data about the candidates on justification forms and evaluating the data to determine if the candidate meets the policy requirements. If the candidate meets the policy requirements, UNet automatically approves the justification form. If the candidate does not meet the policy requirements, UNet marks the justification form for retrospective review by the Liver and Intestine Organ Transplantation Committee.