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Increasing equity in liver transplants

The OPTN Executive Committee has charged the OPTN Liver and Intestinal Organ Transplantation Committee to develop a liver distribution policy that does not use DSAs or OPTN Regions. Prior to that time, the OPTN Liver and Intestinal Organ Transplantation Committee will circulate a proposed liver allocation policy or policies for input in a special public comment period. The OPTN Board of Directors’ decision will be informed by public comments received, data and scientific modeling from the Scientific Registry for Transplant Recipients (SRTR), and the directives included in a HRSA letter dated July 31, 2018. HRSA is not expecting any particular policy outcome, but the OPTN Board of Directors has been directed to act on the liver allocation policy by its December 2018 meeting.

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The OPTN is working to improve the equitable allocation of livers for transplantation for patients across the country waiting for a liver transplant. 

The MELD score is used to assess liver candidates’ severity of illness.  The OPTN is committed to developing a policy to minimize the variance in the median MELD score at transplant across different areas of the country.  

The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee has studied a number of possible solutions. It has widely sought public feedback on concepts to improve liver distribution and reviewed statistical modeling of the possible impact of various options.

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Liver allocation and distribution policy has continued to evolve since it began in 1987.  Changes over time have broadened urgent candidates’ access to liver transplantation and significantly reduced deaths among waiting list candidates.

Per the OPTN Final Rule, OPTN allocation policies must, among other factors, be based on sound medical judgment, seek to achieve the best use of donated organs, and shall not be based on a candidate’s place of residence or listing except to the extent required to satisfy other factors. The OPTN and transplant community must always balance these factors as organ allocation policies are created and changed.