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Policy and system changes effective January 11, 2016, adding serum sodium to MELD calculation

Policy and system changes effective January 11, 2016, adding serum sodium to MELD calculation

Audience:
All liver transplant programs

At-a-glance:
On January 11, 2016, OPTN Policy 9.1 (MELD Score) has been updated to include serum sodium as a factor in the calculation of the MELD score. This policy was approved by the OPTN/UNOS Board of Directors in June 2014. (For additional reference, consult the July 24, 2014 policy notice.) Liver transplant programs may need to report lab values on a more frequent basis for candidates whose MELD scores increase as a result of the new calculation.

How may this affect transplant candidates?

  • The addition of this factor to the MELD calculation will affect the scores of specific transplant candidates in different ways. Some will not change at all. Others may experience an increase of a few MELD points. A small subset of candidates (especially those with serum sodium values lower than 126 mEq/L) may have MELD scores increase by as many as 11 points.
  • Some candidates whose MELD scores increase as a result of this policy will be subject to recertification of their lab values on a more frequent basis, as outlined in OPTN Policy 9.2. Some centers have no candidates whose scores require an updated recertification. A few programs with very large waiting lists may have as many as 40 to 45 candidates affected.
  • As of policy implementation, all MELD candidates except for specific categories listed below will have their match MELD score recalculated. This may result in a change of their recertification due date. For any candidate whose recertification schedule changes such that the new date is either overdue or due within the next seven days, the program will have a full seven-day grace period to allow time to obtain and report updated lab values. So the earliest date updated lab values would be due for any affected candidate will be January 18.
  • Candidates who are Status 1A or 1B at the time of the policy implementation are not affected. Also, candidates who are inactive (Status 7) are not affected. If the status of these candidates changes at a later date, their MELD calculation and reporting schedule will be based on the new values.

Candidates’ MELD scores can change any time their lab values are updated. Please re-run the Liver Candidate MELD/PELD Report, available in UNetSM under Waitlist:Reports, to view your candidates’ recertification dates. The report will display any updated date for those candidates affected by the implementation.

Questions?
If you have policy or general questions, contact your UNOS Regional Administrator at 804-782-4800.
Contact UNOS Customer Service (UNet Help Desk), at 800-978-4334, for system and technical issues.

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