Update National Liver Review Board Guidance Documents and Policy Clarification

At a glance

Current policy

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 reflect their medical urgency for transplant.

The NLRB uses policy and guidance documents to inform their decision to approve or deny a request for an exception score.

Supporting media

Presentation

View presentation slides

Proposed changes

• Include one additional diagnostic criteria for a candidate to receive an automatic exception for cholangiocarcinoma (CCA) in OPTN policy.
• Update NLRB guidance documents for pediatric exceptions, candidates with a neuroendocrine tumor (NET), and candidates with primary (PSC) or secondary sclerosing cholangitis (SSC).

Anticipated impact

• What it's expected to do
  • Provide NLRB members with updated guidance to use when reviewing exception score requests for specific candidates
  • Provide transplant programs with an updated list of diagnostic criteria when submitting a standardized exception request for a candidate with CCA

• What it won't do
  • Will not impact how liver candidates are prioritized on a match run

Themes

• National Liver Review Board (NLRB) improvements

Terms to know

• Candidate: An individual on the organ transplant waiting list
• Transplant program: An organ specific facility within a transplant hospital
• Guidance Documents: Documents that provide more information to transplant programs and NLRB members to use when making decisions on exception requests
• 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.
• Standardized exception: A exception with criteria outlined in policy that is automatically approved when submitted and is not reviewed by the NLRB
• Cholangiocarcinoma (CCA): Bile duct cancer
• Neuroendocrine Tumor (NET): A tumor that forms in the liver
• Primary Sclerosing Cholangitis (PSC): A rare disease that causes scarring in the bile ducts
• Secondary Sclerosing Cholangitis (SSC): A chronic disease similar to PSC caused by a known condition
• Click here to search the OPTN glossary