New expedited process for liver status 1A and 1B listings that do not meet policy criteria

New expedited process for liver status 1A and 1B listings that do not meet policy criteria

Previous Process
Policies on adult and pediatric liver candidate status (3.6.4.1 and 3.6.4.2) state that liver candidates that do not meet the criteria for status 1A or 1B, need to be referred to the Liver & Intestinal Organ Transplantation Committee (liver committee). The liver committee might then refer the case to the Membership and Professional Standards Committee (MPSC) for appropriate action.   Since 2005, a liver subcommittee has reviewed all Status 1A/1B listings that do not meet the policy criteria, however these  reviews only occurred once a quarter.

Process since October 2010:
In August 2010, the review process was modified and the subcommittee now reviews these exception cases in real time so they can provide immediate feedback to the center.  The status exception cases are decided by a majority subcommittee vote. If an exception case is found to be inappropriate, the subcommittee will notify the center with the following options:

• The center may voluntarily downgrade the patient to an appropriate status/score (only an option if candidate has not been transplanted).  No further action will be required.
• The center may appeal the decision by submitting additional clinical information that supports listing at Status 1A/1B, and respond to comments of the reviewers.  The subcommittee will re-review and vote again.
• The center may opt to maintain the 1A/1B Status, with the understanding that cases not resolved will be forwarded to full Liver Committee for further consideration.  The Liver Committee may refer the case to the Membership and Professional Standards Committee (MPSC) for additional review and consideration of disciplinary action. 
• All centers that transplant a single Status 1A/B case that does not meet criteria should receive letters of education and warning, and include a description of the potential disciplinary action if an inappropriate listing occurs again. 
• Centers with more than one inappropriate listing resulting in a transplant over a rolling 2 year period will be referred to full Committee, and to MPSC if Committee agrees.

The Committee will review this process in one year.

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