Effective June 28, 2022, OPTN liver allocation policy bases the calculation of median MELD at transplant (MMaT) scores around the donor hospital instead of the transplant hospital. The median PELD at transplant (MPaT) calculation is not affected by the new policy, as it draws upon transplants performed nationwide. The policy also updates the sorting of candidates to promote greater patient access, particularly among pediatric candidates. The specific changes to policy are detailed in this policy notice.
Candidates with a MELD exception based on MMaT will no longer have a single exception score relative to the transplant program where they are registered. Instead, they will have a MELD score adjustment based on the MMaT of the donor hospital where the match is being run. This means that MELD exception score values may fluctuate based on liver offers from different donor hospitals, and the specific score will not be known until the match is run.
A number of resources are available for transplant programs and liver candidates.
Informational resources
A frequently asked questions (FAQ) document has been posted to the Liver and Intestine resource page of the OPTN website, addressing the new policy and its likely impacts. It includes information for liver transplant candidates and/or their caregivers.
A report listing the MMaT of each donor hospital is also available on the Liver and Intestine resource page of the OPTN website. Liver transplant program staff may use it to look up the MMaT score of donor hospitals from which they are likely to receive donor offers.
In addition, updated help documentation is posted within UNetSM with updated operational definitions and instructions for entering and viewing candidate data.
Educational modules
Two training modules are available in UNOS Connect. The offering numbers and titles are:
- LIV113 – Liver Policy Update: Calculate MMaT around Donor Hospital
- SYS178 – Calculate MMaT around Donor Hospital & Update Sorting within Liver Allocation
Webinar recording available
You may also review the recording of a webinar held June 14. The webinar features a presentation about the changes and responses to questions from participants.
Additional information
Any candidate with an exception score will have that score indexed to the individual donor hospital where the liver offer originates. Previously, with the score indexed to the transplant program, the specific value of that exception score displayed in the patient record. (For example, if a program’s MMaT was 32 and the candidate’s exception score is MMaT-3, the exception score displayed as a 29).
Under the new policy in effect, the candidate record displays the candidate’s assigned exception score value relative to MMaT (for example, MMaT-3) but not a specific value. The specific value will be assigned for each match, based on the MMaT of the donor hospital for which the candidate appears on the match run.
