Calculate Median MELD at Transplant around the Donor Hospital and Update Sorting within Liver Allocation

At a glance

Current policy

When candidates waiting for a liver transplant do not have a model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score that appropriately reflects their medical urgency for transplant, the transplant program may request an exception score.

Currently, many exception scores are assigned based on the median MELD score at transplant (MMaT) around the transplant program where the candidate is listed. This results in higher exception scores for candidates listed at transplant programs with a higher MMaT.

Candidates are currently sorted within classifications on the match run using multiple factors, including waiting time at current MELD or PELD score and time spent on the waitlist at a higher MELD or PELD score.

Supporting media

Presentation

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Proposed changes

• MELD exception scores will be based on the MMaT around the donor hospital rather than the transplant program where the candidate is registered.
• The area around the donor hospital used for calculating MMaT will:
  • Need to meet a minimum threshold of at least two transplant programs and 10 transplants in the previous 365-day period.
  • Start with a 150 NM circle around the donor hospital and increase in 50 NM increments until minimum thresholds are met.
  • For donor hospitals in Hawaii and Puerto Rico, be modified so that the two transplant program threshold will not be required, but the 10 transplant threshold will. If there have not been 10 transplants within the prior 365-day period, the timeframe of evaluation will be extended to 730 days.
• Waiting time used for sorting exception candidates on the match run will change to be length of time since the candidate’s earliest approved exception.
• Non-exception candidates will be ranked ahead of the exception candidates when they have the same MELD or PELD score and blood type compatibility with the donor.

Anticipated impact

• What it's expected to do
  • A candidate’s exception score will be based on a MMaT around the donor hospital
  • MELD exception scores will change with each match run due to varying MMaT’s for each donor hospital
  • Rank non-exception candidates ahead of exception candidates when they have the same MELD or PELD score and blood type compatibility with the donor

• What it won't do
  • Will not change how median PELD score at transplant (MPaT) is calculated

Themes

• Circle size used to calculate MMaT around donor hospital
• Minimum number of transplant programs and number of transplants used to calculate MMaT
• Calculation of MMaT at Hawaii and Puerto Rico donor hospitals
• Ranking candidates with a non-exception MELD or PELD score above candidates with an exception MELD or PELD score when thescore and blood type compatibility is the same

Terms to know

• Candidate: An individual on the organ transplant waiting list.
• Donor Hospital: The hospital where the deceased or living donor is admitted.
• Transplant program: An organ specific facility within a transplant hospital
• Model for End-Stage Liver Disease (MELD): The scoring system used in allocation of livers to candidates who are at least 12 years old that is based on a combination of the candidate’s clinical lab values.
• Pediatric End-Stage Liver Disease (PELD): The scoring system used in allocation of livers to candidates who are under 12 years old
• Median Model for End-Stage Liver Disease at Transplant (MMaT): The MMaT for each transplant program is calculated by using the median of the MELD scores at the time of transplant of all recipients at least 12 years old who were transplanted at hospitals within 250 nautical miles (NM) of the candidates listing hospital in a 365-day period.
• Match run: A process that filters and ranks waiting list candidates based on donor and candidate medical compatibility and organ-specific allocation criteria.
• Classification: A collection of potential transplant recipients grouped by similar characteristics and within a given geographical area. Classifications are used to rank potential recipients of deceased or living donor organs.
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