Six-month monitoring report for updated liver urgency policy shows continued success

Published on: Friday, October 18, 2024

A data report is available detailing the first six months of liver allocation policy after updates were implemented to improve candidate priority based on medical urgency scores. A key intended policy outcome is to increase parity in access to liver transplant among adult male and female candidates. While the six-month interval is a very early monitoring period, the report indicates ongoing progress toward this objective.

Key observations, comparing six months of outcomes before and after the updates took effect, include the following:

For Model for End-Stage Liver Disease (MELD) candidates (aged 12 and older), both the number and rate of liver transplants increased after policy implementation. There were 4,214 deceased donor liver transplants in the pre-policy era, increasing to 4,384 post-policy.
The rate and number of transplants for female MELD candidates increased significantly from the pre- to post-policy timeframe, while the number and rate for male MELD candidates remained roughly the same before and after policy implementation. The number of deceased donor liver transplants for female recipients increased from 1,498 in the six months prior to the policy change to 1,751 in the first six months after the policy took effect.
Transplant rates for MELD candidates became more equal across height groups (and, to a lesser extent, body surface area groups) post-policy compared to pre-policy.
There were no statistically significant changes in the rate of MELD candidates removed from the waiting list due to death or being too sick to transplant.
For Pediatric End-Stage Liver Disease model (PELD) candidates (aged 11 years and younger), there were no statistically significant changes either in transplant rate or the rate of waiting list removal due to death or being too sick to transplant.
The number of pediatric Status 1A and 1B liver transplants decreased from the pre-policy to post-policy era. Recipients with chronic liver disease made up the largest proportion of pediatric Status 1A and 1B transplants, both before and after policy implementation.
The number of pediatric Status 1B cases that qualified by exception (meaning they did not meet standard qualification criteria) decreased from the pre-policy to post-policy timeframe.

The OPTN Liver and Intestinal Organ Transplantation Committee will continue to monitor policy effects, with the next planned report for the one-year period after policy implementation.