Update in Liver and Intestine Allocation Policies for Spring 2019

The recent updates in liver and intestine allocation policies for Spring 2019 include eliminating region and DSA from the allocation model, prioritizing medical urgency and proximity, enhancing pediatric candidate considerations, and adjusting weights for DCD and elderly donors. Acuity Circles Allocation for both adult and pediatric cases have been detailed, along with implementation dates for policy changes and functions of the National Liver Review Board.

• Liver Allocation
• Intestine Allocation
• Pediatric Candidates
• Acuity Circles
• Policy Changes

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1. Liver and Intestine Committee Spring 2019 1

2. Recent Public Comment Proposal Eliminate Region and DSA from Liver and Intestine Allocation Acuity Circles Model approved by the Board Allocation to candidates based on medical urgency and proximity of the transplant hospital to the donor hospital Increased priority for pediatric candidates to receive offers from pediatric donors Increased weight on proximity for DCD and donors over 70 years old 2

3. Acuity Circles Allocation - adult Large circle (500 nm) for status 1 Small circle (150 nm) for 37-40, medium circle (250nm) for 37-40, large circle (500nm) for 37-40 Small circle for 33-36, medium circle 33-36, large circle 33-36 Small circle for 29-32, medium circle for 29-32, large circle 29-32 Small circle for 15-28, medium circle for 15-28, large circle 15-28 Only share for larger circle if no accepts patient in smaller circle

4. Acuity Circles Allocation - pediatric Large circle (500 nm) for pediatric 1A National pediatric 1A and under 12 (only for the donors under 12) Large circle for adult 1A Large circle for pediatric 1B Large circle for PELD Large circle for adolescent MELD National in the same order Then large circles and adult MELD followed by national adult MELD 4

5. Acuity Circles Allocation DCD/>70 Large circle (500 nm) for status 1 Small circle (150nm) for 15-40, medium circle (250nm) for 15-40, large circle (500nm) 15-40 5

6. Policy Implementation Dates Acuity Circles Expected implementation ~April 30 Training beginning in March 6

7. National Liver Review Board 3 national specialty review boards Pediatrics Adult HCC Adult Other Diagnoses Exception scores tied to median MELD/PELD at transplant (MMaT/MPaT) MMaT within 250NM MPaT for the nation 7

8. National Liver Review Board Toolkit https://optn.transplant.hrsa.gov/resources/by- organ/liver-intestine/ Find training for review board members and liver programs on UNOS Connect 8

9. Questions? 9

10. Extra Slides 10

11. Acuity Circle Adult Donor Allocation Sequence Candidates that are within this proximity of the donor hospital: Classification And are: 1 2 3 4 5 6 7 8 9 500nm 500nm 150nm 250nm 500nm 150nm 250nm 500nm 150nm 250nm 500nm 150nm 250nm 500nm National National National 150nm 250nm 500nm National Adult or pediatric status 1A Pediatric status 1B MELD or PELD of at least 37 MELD or PELD of at least 37 MELD or PELD of at least 37 MELD or PELD of at least 33 MELD or PELD of at least 33 MELD or PELD of at least 33 MELD or PELD of at least 29 MELD or PELD of at least 29 MELD or PELD of at least 29 MELD or PELD of at least 15 MELD or PELD of at least 15 MELD or PELD of at least 15 Adult or Pediatric Status 1A Pediatric Status 1B MELD or PELD of at least 15 MELD or PELD less than 15 MELD or PELD less than 15 MELD or PELD less than 15 MELD or PELD less than 15 10 11 12 13 14 15 16 17 18 19 20 21 11

12. Acuity DCD/>70 Donor Allocation Sequence Candidates that are within this proximity of the donor hospital: 500nm 500nm Classification And are: 1 2 3 4 5 6 7 8 9 10 11 12 Adult or Pediatric status 1A Pediatric status 1B MELD or PELD of at least 15 MELD or PELD of at least 15 MELD or PELD of at least 15 Adult or Pediatric status 1A Pediatric status 1B MELD or PELD of at least 15 MELD or PELD less than 15 MELD or PELD less than 15 MELD or PELD less than 15 MELD or PELD less than 15 150nm 250nm 500nm Nation Nation Nation 150nm 250nm 500nm Nation 12

13. Adolescent Donor Allocation Sequence Candidates that are within this proximity of the donor hospital: Classification And are: 500nm 500nm 500nm 500nm 500nm 500nm Nation Nation Nation Nation Nation 500nm 500nm Nation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Pediatric status 1A Adult status 1A Pediatric status 1B Any PELD MELD of at least 15 and 12 to 17 years old MELD less than 15 and 12 to 17 years old Pediatric status 1A Adult status 1A Pediatric status 1B Any PELD Any MELD and 12 to 17 years old MELD of at least 15 and at least 18 years old MELD less than 15 and at least 18 years old Any MELD and at least 18 years old 13

14. Donor <12 Years Old Allocation Sequence Candidates that are within this proximity of the donor hospital: Classification And are: 1 500nm Pediatric status 1A 2 Nation Pediatric status 1A and 0 to 11 years old 3 500nm Adult status 1A 4 500nm Pediatric status 1B 5 500nm Any PELD 6 7 500nm MELD of at least 15 and 12 to 17 years old 500nm MELD less than 15 and 12 to 17 years old 8 Nation Pediatric status 1A and 12 to 17 years old 9 Nation Adult status 1A 10 Nation Pediatric status 1B and 0 to 17 years old 11 Nation Any PELD 12 Nation Any MELD and 12 to 17 years old 13 500nm MELD of at least 15 and at least 18 years old 14 500nm MELD less than 15 and at least 18 years old 15 Nation Any MELD and at least 18 years old 14

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