Two policy changes approved at the November 2011 OPTN/UNOS board meeting directly impact pediatric liver candidates. UNOS implemented these policy changes on Feb. 1, 2012. See policy notice.
The sponsoring committees (Pediatric Transplantation and Liver and Intestinal Organ Transplantation) expect both of these policy changes to eventually be automated through UNet. In the interim, we have implemented a manual process to allow these cases to be listed appropriately according to new policy.
What to do in the Interim
The first policy change eliminated the requirement that pediatric liver candidates must be located in the hospital’s intensive care unit (ICU) to be registered as Status 1A or Status 1B. If a candidate is not located in the hospital’s ICU, but meets all of the requirements of any criterion to be listed as pediatric liver Status 1A or Status 1B, then the transplant program may list that candidate as a “special case” Status 1A or Status 1B, respectively.
In the clinical narrative for these special cases, the listing transplant program must explain:
- which Status 1A or Status 1B criterion the candidate meets
- that the candidate is not in the ICU
- any other pertinent information about the candidate’s current medical condition.
The second policy change allows liver candidates with a biopsy-proven, non-metastatic hepatoblastoma to be listed immediately as Status 1B. This change eliminates the former requirement that these candidates must first be listed at a MELD/PELD score of 30 for 30 days before they can be be listed as Status 1B. The interim, manual process for registering hepatoblastoma candidates as Status 1B is very similar to what is described above. A transplant program caring for a candidate with a biopsy-proven, non-metastatic hepatoblastoma may immediately register that candidate as a Status 1B “special case.”
The clinical narrative that corresponds to this listing must explain that:
- the candidate has a non-metastatic hepatoblastoma
- there is a biopsy to prove this
- the date of the biopsy
In both instances, all properly documented cases will be considered appropriate by the Status 1A/1B Review Subcommittee of the Liver & Intestinal Organ Transplantation Committee.