Liver policy updates

Updated liver and intestinal organ allocation policy to be implemented Feb. 4, 2020

Updated liver and intestinal organ allocation policy to be implemented Feb. 4, 2020

Jan. 18, 2020 – A federal court considering a legal challenge to the liver and intestinal organ allocation policy based on acuity circles has determined, in a ruling issued Jan. 16, 2020, not to issue an injunction on policy implementation. As a result, the OPTN plans to implement the policy on Feb. 4, 2020 to allow for computer programming and notification of members.

Further details relating to policy implementation will be forthcoming soon.

Public comment sought; Liver access for urgent candidates in Hawaii and Puerto Rico

Dec.5, 2019 – The OPTN Liver and Intestinal Organ Transplantation Committee seeks public comment on a proposed variance to liver allocation policy for urgent transplant candidates listed at hospitals in Hawaii and Puerto Rico. The proposed variance would create special distribution units for the state and the territory to ensure they continue to have access to non-local livers upon future implementation of the acuity circles distribution policy.

This proposal is posted to the public comment section of the OPTN website for a special one-month comment period, closing January 9, 2020.

National webinar to present details of the Hawaii and Puerto Rico proposal

During the public comment period, there will be a national webinar to discuss details of the proposal on Wednesday, December 18th from 2:00-2:30 p.m. ET.

Register for the webinar here.

After registering at the above link, participants will receive a confirmation email containing additional information about joining the webinar.

For questions or additional information, send an e-mail to liver@unos.org.

Special public comment session open through Nov. 14

Oct. 15, 2019 – The OPTN Liver and Intestinal Organ Transplantation Committee seeks public comment through Nov. 14, 2019, on a proposed change to a closed variance for allocation of the second segment of split livers. The proposed amendment would align the geographic distribution area within the variance to the geographic distribution units currently in use, as well as those to be used upon future implementation of the acuity circles distribution policy.

This proposal will be posted to the public comment section of the OPTN website for a special one-month comment period, closing Nov. 14, 2019 at midnight Eastern time. The special public comment period will allow the OPTN Board of Directors to take action on the proposal at its December 2019 meeting.

For policy-related questions, send an e-mail to member.questions@unos.org or call 844-395-4428.

Update: Appellate court ruling regarding liver distribution policy

Sept. 26, 2019 – An appellate court ruling issued September 25 is a significant step toward application of the national acuity circles liver distribution policy.  It does not mean that policy implementation will immediately follow.  UNOS is assessing current developments and will provide all members a minimum of 14 calendar days advance notice of any implementation date.

The ruling by the 11th Circuit Court of Appeals unequivocally affirmed the organ allocation policy development process that has been consistently used for more than 20 years.  We believe the decision is very positive for our efforts to make liver allocation more equitable for all candidates.

The court ruling remands certain questions to the district court for further consideration.  We remain confident that the December 2018 liver allocation policy was legally and appropriately adopted after extensive analysis and consideration of feedback from the transplant community and the public.

As soon as we have further guidance on whether UNOS will be able to re-implement the acuity circles policy, we will provide members with at least 14 days’ advance notice before any reprogramming takes effect.

We will keep you informed of additional key developments.

For policy-related questions, send an e-mail to member.questions@unos.org or call 844-395-4428.

NLRB update: MMaT calculation now based on DSA of transplant hospital

May 24, 2019Key updates and actions:

  • MMaT now calculated by DSA of liver transplant hospital
  • Scores converted as of 10:15 p.m. EDT May 24
  • Waiting time may be adjusted upon request if MELD exception score increased
  • Median PELD at transplant (MPaT) is not affected

Note: To see the most up-to-date information on the OPTN website, make sure you always refresh your browser or clear your cache. You can accomplish this by pressing Ctrl F5 on your keyboard.

Effective May 24, 2019, at 10:15 p.m. EDT, the median MELD at transplant (MMaT) scores for liver candidates with exception scores are now based on recent liver transplants performed at liver transplant hospitals within the donation service area (DSA) where the candidates are listed.

When the National Liver Review Board (NLRB) was implemented on May 14, 2019, at the same time as the acuity circles distribution model, the basis of the MMaT calculation was recent transplants at all liver transplant hospitals included in a 250 nautical mile radius of the hospital listing the exception candidate.  With the reversion to a donation service area (DSA) and region-based liver allocation system effective May 23, some DSAs had different MMaT scores among liver programs within their area.  This in turn could create disparities affecting candidates’ transplant access within the local DSA of the donor.

The OPTN Executive Committee, by teleconference May 24, unanimously approved basing the MMaT calculation on DSA to address unintended consequences of the reversion to DSA-based liver allocation.

The conversion has been made within UNetSM for all liver transplant candidates who had an exception score based on MMaT within a 250 nautical mile radius.  Please refer to this table for the MMaT score for each liver transplant program based on DSA.  If you wish to compare it to the MMaT based on 250 nautical mile circles, this table lists the previous scores.

Many individual candidates’ MMaT will remain the same under the conversion as it was under the previous calculation.  Other candidates will have their exception scores either increase or decrease.

You may apply to UNOS to have a candidate’s waiting time adjusted only if the candidate experiences an increase in their MELD exception score as a result of this action.  The waiting time adjustment will include time the candidate had at a lower exception score from the May 14 initiation of NLRB up until this action. To request a waiting time adjustment for a candidate, please submit a Waiting Time Modification form.  These forms are located in UNetSM; navigate to the WaitListSM, then on the top menu select “Resources”, then select “Forms/Tools.”

Median PELD at Transplant (MPaT) is unaffected by this action.  MPaT is the same for all transplant programs with PELD exception candidates and will remain at 35.

As always, transplant programs may request individual exception scores for candidates by the procedure set forth in OPTN Policy 9.4 (MELD or PELD Score Exceptions).

If you have questions about data or information systems, contact UNOS Customer Service at 800-978-4334.  For policy-related questions, send an e-mail to member.questions@unos.org or call 844-395-4428.

OPTN liver allocation policy reverted to DSA and regions

May 23, 2019 – OPTN Policy 9 (Allocation of Livers and Liver-Intestines) has reverted to use of the donation service area (DSA) and regional distribution boundaries in effect prior to May 14, 2019. This action complies with a federal court order dated May 17, 2019.

The National Liver Review Board (NLRB) remains in effect. Candidates’ currently assigned exception scores did not change. As always, transplant programs may request individual exception scores for candidates by the procedure set forth in OPTN Policy 9.4 (MELD or PELD Score Exceptions).

Resources

The updated liver allocation policy is available in the Policies section of the OPTN website.

Online help documentation covering UNetSM functionality is also available.

Questions? If you have questions about data or information systems, contact UNOS Customer Service at 800-978-4334. For policy-related questions, send an e-mail to member.questions@unos.org or call 844-395-4428.

Pre-implementation notice: OPTN liver allocation policy to revert to DSA and regions May 23, 2019

May 21, 2019 – On May 23, 2019, OPTN Policy 9 (Allocation of Livers and Liver-Intestines) will revert to use of the donation service area (DSA) and regional distribution boundaries in effect prior to May 14, 2019. This action is being taken in compliance with a federal court order dated May 17, 2019.

The UNOS Secure EnterpriseSM system, which includes UNetSM and other transplant applications such as WaitlistSM, DonorNet®, TIEDI® and KPDSM, will be unavailable for a brief period the morning of May 23 to allow for implementation. These services will be offline from 7:00 a.m. EDT until approximately 8:00 a.m. EDT. Please save all data prior to this time.

In all instances, organ procurement organizations and liver transplant programs should continue to follow the match run generated in UNetSM for liver donors and potential recipients.

The National Liver Review Board (NLRB) will remain in effect. Candidates’ currently assigned exception scores will not change.

Resources

The allocation policies in effect as of system implementation will be posted to the Policies section of the OPTN website.

Online help documentation covering UNetSM functionality is also available.

Questions? If you have questions about data or information systems, contact UNOS Customer Service at 800-978-4334. For policy-related questions, send an e-mail to questions@unos.org or call 844-395-4428.

Liver policy to revert to DSA-based system due to court order

May 17, 2019 – The Health Resources and Services Administration (HRSA) has instructed UNOS, as the OPTN contractor, to revert to the liver distribution policy in place prior to May 14, 2019, utilizing boundaries based on donation service areas and regions, consistent with a federal court order. For further information, refer to a HRSA letter to UNOS and UNOS’ reply to HRSA on May 17, 2019.

In all instances, organ procurement organizations and liver transplant programs should continue to follow the match run generated in UNetSM for liver donors and potential recipients.

We understand that these events are unfolding rapidly. We will continue to keep you informed of new developments.

Court order cease and desist on further liver policy implementation

May 15, 2019 – UNOS received an Order from a federal court in Atlanta not to do further work implementing the new liver allocation policy approved by the OPTN Board of Directors in December 2018. As the policy has already been implemented, we are seeking clarification from the judge. In the meantime, OPOs and transplant centers should follow the match runs that UNet generates. If we make changes to UNet, we will notify the community.

Liver policy changes and National Liver Review Board in place

May 14, 2019 – Today, a federal court in Atlanta denied a request to delay implementation of the liver distribution policy approved by the OPTN Board of Directors in December 2018. The plaintiffs have indicated an intent to appeal that ruling and as of this message, no injunction has been ordered that would further delay implementation of the policy. As a result, the new policy will go into effect on May 14.  Implementation of the National Liver Review Board (NLRB) will also go into effect on the same date, and the planned conversion of exception scores for most candidates who have current exceptions will take place at that time. The transplant community, including a committee comprising transplant experts, organ recipients, and donor families from around the country and the OPTN Board of Directors—with extensive input from the public—came together to develop and approve the new policy. Simulation modeling of the new policy suggests it will be fairer to patients nationwide, save more lives by reducing pre-transplant deaths, and improve transplant access for children in need of a transplant. Additional details about the policy are available on the liver distribution page on the UNOS website.

Learn more about the liver distribution policy approved by the OPTN Board of Directors in December 2018.

Learn how liver candidates are prioritized for transplant and about the national liver review board (NLRB)

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