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Making liver distribution fair and equitable

With more than 10,000 people waiting for a lifesaving liver transplant, ensuring equitable liver allocation is a priority for the entire donation and transplant community. Liver distribution policy makes the system work efficiently and fairly for all transplant patients regardless of where they live, what hospital they choose for their care, or how sick they must be before they are likely to get a transplant.

Since the current liver and intestine policy took effect in 2020, liver transplants have increased by 4.3 percent. This policy prioritizes the medical urgency of liver transplant candidates in relation to the distance between the donor hospital and transplant hospital. Patients who are both most in need and closest to the donor get offers first.

But liver and intestine policy is still undergoing transformation — learn about continuous distribution, the future state of liver and intestine allocation.

Liver-intestine news

Transplant recipient, Abby, smiling with mom looking up at her

Read stories of hope about patients like Abby

How do patients benefit?

Data monitoring of the current policy shows:

  • Fewer people die waiting for a liver transplant
  • More children, 12 and older, are receiving liver transplants
  • How sick a patient is takes priority over where they live

How it works

How are patients matched?

  • How are candidates matched with available organs?
  • How are we working to improve the matching process?

Distribution for liver

How was the policy developed?

This transformative policy was developed by transplant experts, organ recipients and donor families from around the country, with consideration of more than a thousand public comments.

Policy development

Magnifying glass inspecting data charts

How do we track policy success?

We look at the data.

Liver transplants* increased by 4.3 percent since policy implementation.

Policy monitoring reports

24-month: *Deceased donor liver-alone transplants

What is medical urgency?

  • What are Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD)?
  • How do they work?
  • How are we working to improve them?


What are exception scores?

  • Why might a candidate need an exception score?
  • How is that score determined?
  • What is the National Liver Review Board (NLRB)?

Exception scores

Icon of a patient

For patients

About liver transplantation

Information for patients on: Who needs a liver transplant? How are liver transplants performed? How do I become a liver transplant candidate?

Answers on Transplant Living

What happened in public comment? See what the community had to say. View comments

Essential reading and resources

Policy information on OPTN

For patients

For professionals

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