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Policy implementation notice: National Liver Review Board enhancements effective August 4

Policy implementation notice: National Liver Review Board enhancements effective August 4


Liver transplant program directors, surgeons, physicians, administrators, clinical coordinators, compliance and quality managers

Implementation date: August 4, 2020


On Tuesday, August 4, 2020, several enhancements were implemented regarding the National Liver Review Board (NLRB). None of the changes requires you to update current or recent NLRB requests for your liver transplant candidates. You should, however, review these enhancements to determine any impact on your clinical practice.

The OPTN Board of Directors approved the changes at its June 2020 Board meeting. Complete details are contained in this policy notice on the OPTN site. The changes in effect are listed below.

One additional component of the approved changes, also addressed below, is not yet in effect and will require system programming. UNOS will notify you separately when the effective date is set for that component.

Actions effective August 4, 2020

  • Changes to OPTN policy that:
    • align the scope of the NLRB with the updated operational guidelines
    • clarify the update schedule for median MELD at transplant (MMaT) and median PELD at transplant (MPaT) to allow for more time to calculate, communicate, and implement the new scores.
  • Updates to the NLRB operational guidelines that:
    • clarify the scope of the NLRB by instructing reviewers to base decisions on the medical urgency of the candidate
    • adjust the threshold and schedule for removing inactive reviewers to reflect differences in individual reviewer caseloads and allow for more timely removal of inactive reviewers
    • outline the process for final appeals to the Liver and Intestinal Organ Transplantation Committee
  • Updates to the NLRB guidance documents for adult MELD exception review and for exception review of adults with hepatocellular carcinoma. The updates:
    • add guidance for secondary sclerosing cholangitis (SSC) and adults with metabolic disease
    • remove unnecessary language for portopulmonary hypertension (POPH)
    • clarify that candidates who had HCC more than two years ago that was treated but then recurs should be considered the same as those with no prior HCC only when applying for an initial exception.

Pending later implementation

An item also approved under the NLRB enhancements, but subject to IT system programming, is a provision that will allow automatic approval of any candidate with hepatocellular carcinoma (HCC) meeting standardized extension criteria. You will receive advance notice of the effective date of this action.

What you need to do

Please familiarize yourself and your clinical staff with the new provisions and clarifications.

These updates do not change any details relating to the sequence of matches for candidates or to the OPTN Member Evaluation Plan.


If you have questions relating to implementation, contact UNOS Customer Service at 800-978-4334. For policy-related questions, send an e-mail to [email protected].

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