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How are candidates matched with available livers?

Livers from adult deceased donors first are offered to a wide area for candidates in the most urgent (Status 1A and 1B) designations, because they are at great risk of imminent death without a transplant. At any given moment, there are generally fewer than 50 Status 1A and 1B candidates listed nationwide.

Under the policy, livers from all deceased donors are offered for compatible Status 1A and 1B candidates listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital.

Distribution example video

In the example here, transplant hospitals A, B and C all have Status 1A or 1B candidates compatible with the donor and are located within a 500 nautical-mile radius of the donor hospital.

After that, livers from deceased adult donors are distributed in one of two ways depending on the donor’s age and mechanism of death. The examples below illustrate how the system works based on different characteristics of the deceased donor.

Adult, non-DCD donors younger than age 70

The majority of deceased liver donors are adults who are under age 70 and who are not donating upon cardiorespiratory death (also known as DCD donation). For livers from these donors, after initial offers to Status 1A and 1B candidates as above, the next steps in distribution are as follows:

  • candidates with a MELD or PELD score of 37 or higher listed at transplant hospitals within a radius of 150 nautical miles from the donor hospital
  • candidates with a MELD or PELD score of 37 or higher listed at transplant hospitals within a radius of 250 nautical miles from the donor hospital
  • candidates with a MELD or PELD score of 37 or higher listed at transplant hospitals within a radius of 500 nautical miles from the donor hospital
  • a continuing sequence of progressive offers, from more local to more distant (at transplant hospitals within 150, 250 and 500 nautical miles of the donor hospital), for candidates with ranges of MELD or PELD scores from 33 to 36, from 29 to 32, and from 15 to 28

In this example:

  • Transplant hospital A is within the 150 nautical-mile radius. Candidates at that hospital with a MELD or PELD of at least 37 are first to receive compatible liver offers.
  • The next candidates to receive offers are those who have a MELD or PELD of at least 37 and who are listed at hospitals C and D, both of which are within the 250 nautical-mile radius.
  • Candidates with a MELD or PELD of at least 37 and listed at hospitals B, E and F then receive offers, as they are beyond the 250 nautical-mile radius but are within 500 nautical miles.
  • The sequence continues to repeat for compatible candidates with progressively lower ranges of medical urgency. For example, the next group of candidates to receive offers are those listed at Hospital A with a MELD or PELD between 33 and 36, followed by those at hospitals C and D with the same range of scores, then those at hospitals B, E and F with the same range of scores.
Adult donors age 70 or older and/or DCD donors

For deceased donors older than age 70, and/or who die as a result of cardiorespiratory failure, the distribution sequence provides earlier access for candidates more local to the donor hospital. Most livers from these donors are accepted for local candidates, since they are most viable when the preservation time between recovery and transplantation is brief.

For livers from these donors, after initial offers to Status 1A and 1B candidates as above, the initial distribution sequence is as follows:

  • compatible candidates with a MELD or PELD of 15 or higher, listed at transplant hospitals within a 150 nautical-mile radius of the donor hospital
  • compatible candidates with a MELD or PELD of 15 or higher, listed at transplant hospitals within a 250 nautical-mile radius of the donor hospital
  • compatible candidates with a MELD or PELD of 15 or higher, listed at transplant hospitals within a 500 nautical-mile radius of the donor hospital

In this example:

  • Offers go to any compatible candidates with a MELD or PELD of at least 15 listed at Hospital A, which is within 150 nautical miles of the donor hospital.
  • Next, offers go to any compatible candidates with a MELD or PELD of at least 15 listed at Hospitals C or D (within a 250 nautical-mile radius).
  • Offers then go to candidates at Hospitals B, E or F (500 nautical-mile radius).
Pediatric (younger than age 18) donors

For pediatric liver donors (younger than age 18), the policy generally increases priority for pediatric candidates before adult candidates at the same level of medical urgency. Livers from pediatric donors are offered initially to compatible pediatric candidates listed at any transplant hospital within a 500 nautical-mile radius of the donor hospital.

In this example, pediatric transplant candidates listed at transplant hospitals A, B or C are all within the initial level of distribution for compatible donor offers.

Exceptions for geographically isolated areas

Liver transplant programs located in Hawaii and Puerto Rico are geographically isolated from the continental United States. A variance addresses exceptions for Hawaii and Puerto Rico. To address potential challenges to candidate access in those areas, blood type O livers recovered in those two donation service areas are offered for all local candidates, regardless of blood type, before being offered to any candidates outside those areas.

Also, no transplant program exists in the state of Alaska, and all U.S. transplant programs are beyond a 500 nautical mile distance from donor hospitals in Alaska. Any livers recovered from an Alaskan hospital are considered as originating from the Seattle Tacoma Airport in Washington State.

Magnifying glass inspecting data charts

How do we track policy success?

We look at the data.

Liver transplants* increased by 5.1 percent since policy implementation.

Policy monitoring reports

18-month: *Deceased donor liver-alone transplants
Doctor with hand on patient's shoulder

How do patients benefit?

Data monitoring shows that the policy means:

  • 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

Proximity of donor hospitals to transplant centers

See the distance between donor hospitals and selected liver transplant centers across the country.

View interactive map

“Donated organs are so very precious. We must do all things possible to distribute them as widely as possible so that they are utilized by the right patients at the right time to reduce the number of people who die waiting.”

Tami Houston, liver recipient, Woodlands, TX

“Cameron’s recipients were hours and days from dying, without his life saving organ they wouldn’t be here today! As donor families we choose to give life and want to see our loved ones’ precious gifts go to the people most in need wherever they are.”

Sarah Fisher, donor mother, Fargo, ND

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