Further Enhancements to the National Liver Review Board

At a glance

What is current policy and why change it?

The National Liver Review Board (NLRB) reviews requests from transplant programs for candidates whose model for end-stage liver disease (MELD) score or pediatric end-stage liver disease (PELD) score does not accurately reflect their medical urgency for transplant. The NLRB can approve or deny the request. If the NLRB denies the request, the transplant program can appeal the case.

The NLRB uses policy, guidance documents, and operational guidelines to inform their decision to approve or deny a request. Based on feedback and lessons learned, the committee wants to update those documents so the process works better for programs and candidates.

Further Enhancements to the National Liver Review Board

Dr. James Trotter, Chair of the OPTN Liver and Intestinal Organ Transplantation Committee, reviews the Further Enhancements to the National Liver Review Board policy proposal.

Terms you need to know

Candidate: An individual on the organ transplant waiting list
Transplant program: An organ specific facility within a transplant hospital
Operational Guidelines: Standard operating procedures for how the representatives on the NLRB are appointed and how and when reviews for exception requests are approved, denied or appealed
Guidance Documents: Documents that provide specific clinical information to transplant programs and NLRB members to use when evaluating common exceptions
Model for End-Stage Liver Disease (MELD): The scoring system used in allocation of livers to candidates who are at least 12 years old
Pediatric End-Stage Liver Disease (PELD): The scoring system used in allocation of livers to candidates who are under 12 years old
National Liver Review Board (NLRB): A review board of members drawn from a nationwide pool of liver transplant physicians and surgeons, who review exception requests from transplant programs for candidates whose automatically calculated model for end-stage liver disease (MELD) score or pediatric end-stage liver disease (PELD) score does not accurately reflect the candidate’s medical urgency for transplant.
Appeals Review Team (ART): Nine randomly selected members from the NLRB who meet by conference call to review appeals for exception cases denied by the NLRB
Portopulmonary hypertension (POPH): Pulmonary arterial hypertension complicated by portal hypertension
Hepatocellular Carcinoma (HCC): A cancer arising from liver cells (hepatocytes)

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What’s the proposal?

The proposal includes changes to policy, operational guidelines, and guidance documents.

What’s the anticipated impact of this change?

What it’s expected to do
- Provide updated clinical requirements in policy for transplant programs submitting an exception request for a candidate with portopulmonary hypertension (POPH)
- Provide a more effective process for reviewing Post-Transplant Explant Pathology forms for candidates listed with hepatocellular carcinoma (HCC)
- Provide more guidance for National Liver Review Board (NLRB) members when reviewing exception score requests for candidates with polycystic liver disease (PLD)
- Create a pediatric specific Appeals Review Team (ART) to review appeals for pediatric candidate exception requests
- Add a member of the Liver and Intestinal Organ Transplantation Committee as the ART leader
What it won’t do
- This proposal will not impact how liver candidates are prioritized on the match run to receive a potential transplant