Continuous Distribution of Livers & Intestines Update, Summer 2024

At a glance

Background

In December 2018, the OPTN Board of Directors approved the continuous distribution framework for allocation of all organs. Continuous distribution will rank waiting list candidates based on points related to various factors, such as medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency. Continuous distribution will remove the boundaries between classifications and will increase equity for candidates and transparency in the system.

This concept paper provides an overview of the project’s development, progress to date, and next steps for continuous distribution of liver and intestines. The paper requests community feedback that will assist the Liver and Intestinal Organ Transplantation Committee’s work.

Supporting media

Presentation

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Requested feedback

Feedback on the identified attributes as well as their drafted purposes.
Feedback on the Committee’s decision to utilize MELD and PELD as the medical urgency score model within the first version of continuous distribution.
Feedback specific to the pediatric population within liver continuous distribution.
Feedback on when organizations begin to fly rather than drive for organ procurement.
Feedback on how to incorporate utilization efficiency as an attribute.
Feedback on any other aspects of this project including any additional considerations that are not addressed in this paper.

Anticipated impact

What it's expected to do
- Provide a more equitable approach to matching candidates and donors
- Remove hard boundaries between classifications that prevent candidates from being prioritized higher on the match run
- Establish a system that is flexible enough to work for each organ type

What it won't do
- This paper is not a proposed policy change but will help the Liver and Intestinal Organ Transplantation Committee develop a future policy proposal

Terms to know

Attributes: Attributes are criteria we use to classify then sort and prioritize candidates. For example, in liver allocation, criteria include model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score, blood type compatibility, distance between donor hospital and transplant program, and others.
Composite Allocation Score: A composite allocation score combines points from multiple attributes together. This concept paper proposes the use of composite allocation scores in a points-based framework.
Rating Scale: A rating scale describes how much preference is given to candidates within each attribute.
Weights: Weights reflect the relative importance or priority of each attribute in the overall composite allocation score. Combined with the ratings scale and each candidate’s information, this results in an overall composite score for prioritizing candidates.
Mathematical Optimization: A tool that starts with specific outcomes and then finds policy scenarios with relative weights that will accomplish those desired outcomes.
Organ Allocation Simulator (OASim) Modeling: A tool that models the potential impact of specific developed policy scenarios.