Upcoming changes to listing procedures for pediatric liver candidates

Pediatric Liver Status 1A and Status 1B Candidates Not in ICU

Background
At its November 2011 meeting, the OPTN/UNOS Board of Directors voted to eliminate the requirement that pediatric Status 1A and 1B liver candidates must be in the hospital’s intensive care unit (ICU) at the time of application.  Refer to Policy 3.6.4.2 (Pediatric Candidate Status).

These policy changes will be implemented on February 1, 2012. Until these changes are programmed in UNet^SM, transplant centers may list pediatric liver candidates that are not in the ICU and meet Status 1A or 1B criteria using the following process:

1. List the candidate as a “special case” Status 1A or 1B if s/he meets all the requirements of any criteria for pediatric liver Status 1A or Status 1B (Policy 3.6.4.2, i – vi) but is not in the ICU.
2. In the narrative for these special cases:
   a. Specify which Status 1A or 1B criteria the candidate meets
   b. Explain that the candidate is not in the ICU
   c. Provide any other pertinent information about the candidate’s current medical condition

Listing Pediatric Liver Candidates with Hepatoblastoma

Background
The OPTN/UNOS Board of Directors approved modifications to Policy 3.6.4.2 (Pediatric Candidate Status) and eliminated Policy 3.6.4.4.1 (Pediatric Liver Transplant Candidates with Hepatoblastoma) at its November 2011 meeting. By eliminating the current requirement that candidates with a non-metastatic hepatoblastoma be listed initially with a MELD/PELD score of 30 for 30 days, centers may now list candidates as Status 1B immediately.

These policy changes will be implemented on February 1, 2012. Until these changes are programmed in UNetSM, transplant centers may list candidates with hepatoblastoma using the following process:

List all pediatric liver candidates with hepatoblastoma confirmed by biopsy as a Status 1B “special case.”

1. In the narrative for these special cases:
   a. Clearly explain that the candidate has a non-metastatic hepatoblastoma
   b. List the date of the biopsy proving the candidate has a non-metastatic hepatoblastoma

If you have any questions about either of these processes, please contact your Regional Administrator at 1-804-782-4800.