Policy change: Automatic approval of exception extensions for certain HCC candidates

Policy change: Automatic approval of exception extensions for certain HCC candidates

Audience
Liver Transplant Programs: Directors, Surgeons, Physicians, Administrators, Data Coordinators and Clinical Coordinators
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Implementation
February 5, 2018

At a glance
OPTN Policy 9.3.F (Extensions of HCC Exceptions) was amended February 5. It restored automatic approval for exception extension requests for a subset of HCC candidates with treated lesions that fall below the eligibility criteria for an initial exception request. Please note, however, that such candidates who came due for an exception extension between December 12, 2017 and February 4, 2018, must continue to receive regional review board approval for any subsequent extension requests.

More details
On December 12, 2017, policy changes were implemented to HCC criteria for auto approval as approved by the OPTN/UNOS Board of Directors In December 2016. A result of the changes implemented at that time was the removal of a subset of candidates with an approved exception for hepatocellular carcinoma (HCC) with treated lesions that fall below the eligibility criteria for an initial exception extension request. These candidates therefore required review board approval to receive an extension of their exception score.

The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee intended to allow these candidates to continue to receive automatic approval of their HCC exception at time of extension, as they had prior to the recent policy change. The committee proposed a public comment item to restore this provision. Following public comment, the committee recommended this proposal to the OPTN/UNOS Executive Committee on February 2. The Executive Committee approved the action, with an effective date of Monday, February 5.

For HCC candidates who did not require an exception extension between December 12, 2017, and February 5, 2018, no change will be required to your processes. Candidates who meet the new qualifying criteria will be eligible for an automatic extension of their exception score.

For HCC candidates who did require an exception extension between December 12, 2017, and February 5, 2018, the extension request was conveyed to the regional review board for approval. For these candidates only, any subsequent exception extension request will continue to require regional review board consideration as long as the candidate maintains an exception score.

Updated training and FAQ document available
An update has been made to the recorded training session available on UNOS Connect in the Liver section of the Course Catalog that outlines the policy and associated changes for assessment and data reporting for eligible candidates. A PDF version of the slide set is also available as a separate link.

An update has also been made to a list of frequently asked questions about HCC exception policy. In particular, there is a new entry that addresses treatment of a single lesion between 2 cm and 3 cm.

Contact
If you have questions about new or updated data requirements, contact the UNet Help Desk at (800) 978-4334 or unethelpdesk@unos.org. Contact your regional administrator at 804-782-4800 if you have policy-related questions.

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