NLRB postponed; public comment sought on interim MMaT
The new liver distribution system based on acuity circles is scheduled for implementation April 30, 2019. The policy, approved by the OPTN/UNOS Board of Directors in December 2018, replaces donation service area (DSA) and regional boundaries with consistent geographic distribution units based on a combination of candidates’ level of medical urgency and the relative distance from donor to transplant hospitals.
SRTR modeling of the new system suggests it will:
- Reduce pre-transplant deaths
- Increase transplant rates for pediatric recipients
- Reduce geographic variation in MELD scores at transplant
The National Liver Review Board (NLRB) implementation, originally scheduled for January 31, 2019, is postponed. Unintended consequences were identified in the plan to base the model for end stage liver disease (MELD) exception scores on median MELD at transplant during the transitional period between NLRB implementation and implementation of the liver distribution system.
The OPTN/UNOS Executive Committee voted January 30 to seek public comment on calculating a median MELD at transplant (MMaT) score on the basis of the donation service area (DSA) in which the liver transplant center is located. This proposed alternative may replace, on an interim basis, the MMaT calculation based on transplants performed at hospitals within a 250 nautical mile radius of the hospital where the exception candidate is listed.
This proposed interim approach would only be used for the period of time between NLRB implementation and implementation of the liver distribution system based on acuity circles. The current liver regional review boards (RRBs) will continue to function until NLRB implementation, which will be set at a future date to be determined after consideration of the public comments.
Resources to help you prepare for both liver distribution and NLRB implementation are available on the OPTN website. In addition, various training modules and resources are available in UNOS Connect under the Liver category of offerings.
For questions or further information
If you’d like to know more about existing policies, please visit the Liver and Intestinal Organ Transplantation Committee’s page on the OPTN website, call UNOS toll-free at 844-395-4428, or send an email to firstname.lastname@example.org. If you’d like to know more about projects or proposals our committee continues to discuss, contact your regional representative to the committee or send an e-mail to email@example.com.
Learn more about the new liver system and how it will benefit patients here.