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Effective now, reinstating an “override” functionality for unresolved RRB exception requests

Effective now, reinstating an “override” functionality for unresolved RRB exception requests

Audience:

  • All liver transplant programs

As of February 4, 2016, WaitlistSM has been updated to allow liver transplant programs to apply an “Override” MELD/PELD exception score in cases where an exception request to the Regional Review Board (RRB) is either denied or in an indeterminate status. Indeterminate status describes a case in which a majority was not achieved and the RRB chair could not break the tie. The override function replaces an earlier process that had been known as “No Appeal/No Withdraw.”

Transplant programs should only use this feature if there is no resolution of an exception score following a conference call between the treating physician and the RRB.

While the exception score will be applied, any instance of an override will result in an automatic referral for review by the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee. In turn, the matter may be referred for additional consideration by the OPTN/UNOS Membership and Professional Standards Committee.

If the RRB fails to vote on an exception request within 21 days, the candidate will be awarded the requested exception score by default. This is unchanged from the current system.

Requests denied or in indeterminate status prior to February 4, 2016 will not have the option to override. Please contact the UNOS Regional Review Board staff member if you require assistance.

This action was approved by the OPTN/UNOS Board of Directors in June 2009.

How should programs proceed if an exception request is denied or indeterminate?

  • After submitting an exception in UNetSM, the candidate’s physician and RRB have up to 21 days to discuss assignment of an exception score. If the RRB denies the transplant program’s request within that 21-day period, the program will have three options: “Appeal,” “No Appeal” or “Override.” The “Override” function will also display when a request is indeterminate. These options are accessible in the candidate’s record in WaitlistSM or through either the MELD Exception History Report or MELD Exception Extension Management Report.
  • Selecting the “Appeal” option will create a new online appeal for an online RRB vote. To request a conference call to discuss the appeal, contact UNOS’ Regional Review Board staff (contact information is below).
  • If a program has not appealed a denied request within 21 days, the “Appeal” option will no longer appear; however, the program can select the “Override” option. We recommend that you contact your UNOS Regional Review Board staff member to discuss your options before choosing to override.
  • The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee will be notified of any “Override” request and will review the circumstances. At the committee’s discretion, it may also refer the case to the OPTN/UNOS Membership and Professional Standards Committee for additional review and potential action.

Questions?

If you have policy or general questions, contact your UNOS Regional Administrator at 804-782-4800.

If you have specific questions or needs relating to exception requests or appeals, contact your UNOS Regional Review Board staff member, either by e-mail (reviewboardstaff@unos.org) or by phone:

  • Aaron McKoy (Regions 1, 4, 6, 10): (804) 782-6575
  • Larita Jones (Regions 2, 7, 9): (804) 782-4620
  • Brenda Boateng (Regions 3, 5, 8, 11): (804) 782-2985

Contact UNOS Customer Service (UNet Help Desk), at 800-978-4334, for system and technical issues.

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