OPTN/UNOS Board Approves Updated Liver Distribution System

The OPTN/UNOS Board of Directors, at its meeting December 3, approved a new liver distribution policy to establish greater consistency in the geographic areas used to match liver transplant candidates with available organs from deceased donors and reduce geographic differences in liver transplant access.

The policy will replace fixed, irregular local and regional geographic boundaries historically used to match liver candidates based on the donor location. It initially prioritizes liver offers from most deceased adult donors in the following sequence:

  • Candidates with highest medical urgency (Status 1A and 1B) listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital

  • 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 similar, continuing sequence of progressive offers (candidates 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 addition, livers from deceased donors younger than age 18 will first be offered to any pediatric candidates (younger than age 18) listed at any transplant hospital within a 500 nautical-mile radius of the donor hospital. This will give additional priority to pediatric transplant candidates compared to the current distribution system.

Simulation modeling of the approved system indicates it will reduce variation in transplants by MELD score that exist in various areas of the country under the current liver distribution system. Modeling further suggests it will reduce pre-transplant deaths and increase access for liver transplant candidates younger than age 18.

Source: UNOS.org

Jaime Scholl