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National Liver Review Board guidance documents updated

National Liver Review Board guidance documents updated

Effective July 15, 2021, updates are in effect for two National Liver Review Board (NLRB) guidance documents. The OPTN Board of Directors approved the revised guidance at its June Board meeting.

The guidance documents have been updated on the OPTN website to reflect the new information. Please familiarize yourself and your staff as applicable with the updated guidance as it may relate to candidates in your care.

Several updates have been made to the pediatric guidance for MELD or PELD exceptions, including the following:

  • expanded guidance for candidates with growth failure or nutritional insufficiency
  • additional instruction for information that should be submitted for candidates with the following conditions:
    • gastrointestinal bleeding needing ongoing transfusion
    • serum sodium less than 130 g/dL on two occasions more than two weeks apart
  • specification that a candidate should have at least two thoracenteses in the last 60 days not including the diagnostic thoracentesis
  • recommendation of an exception for candidates requiring a hospitalization of at least five days with ascites not adequately controlled by oral diuretics and requiring IV diuretic therapy
  • additional guidance for candidates with rare metabolic disorders
  • an updated conclusion section to allow submission and consideration of clinical details not previously included in guidance

Updates have also been made to adult MELD exception guidance for non-HCC candidates, including the following:

  • clarification of requirements for candidates with a neuroendocrine tumor, including removal of the recommendation that such candidates be less than 60 years old
  • updated guidance for candidates with primary or secondary sclerosing cholangitis, recommending that they may qualify if they are admitted to the hospital two or more times in the previous year with documented blood stream infection or evidence of sepsis including hemodynamic instability requiring vasopressors

Please note that in the same action approving these updates to the guidance documents, the OPTN Board also approved an update to OPTN Policy 9.5.A, which addresses exception requirements for candidates with cholangiocarcinoma. That updated policy will take effect at a later date, and you will receive separate notification in advance of that implementation date.


If you have operational questions about the NLRB, contact UNOS’ Review Board staff at [email protected].

You may submit other questions or feedback to [email protected].

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