Update on Continuous Distribution of Livers and Intestines, 2023

At a glance

Current policy

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 for various factors, such as medical urgency, candidate biology, patient access, and placement efficiency. Continuous distribution will remove the hard boundaries built into the current framework to increase equity for patients and transparency in the system.

This update contains results from the values prioritization exercise that was open to the public during the Winter 2023 public comment period. The paper will detail recent discussions and decisions regarding specific attributes, such as geographic equity and post-transplant survival. Additionally, it will provide an overview of the next steps for the continuous distribution of livers and intestines projects.

Click the link for a closer look at Continuous Distribution: https://optn.transplant.hrsa.gov/policies-bylaws/a-closer-look/continuous-distribution/

Supporting media

Presentation

View presentation

Requested feedback

The community is asked to provide feedback on the committee’s progress to date and the plan for moving the project forward
The committee is seeking feedback on specific topics such as

Including post-transplant survival in the calculation
Amount of priority for proximity
How to measure geographic equity

Anticipated impact

What it's expected to do

Provide a more equitable approach to matching candidates and donors.
Remove hard boundaries 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 request for feedback is not a proposed policy change, but will help the Liver and Intestinal Organ Transplantation Committees develop a future policy proposal.

Terms to know

Attribute: Criteria used to classify then sort and prioritize candidates. For example, in liver allocation, criteria include medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency.
Analytical Hierarchy Process (AHP): An exercise to assist with decision-making that asks participants to rate the importance of an attribute when it is compared to another attribute.
Composite Allocation Score: Combines points from multiple attributes together. This request for feedback proposes the use of composite allocation scores in a points-based framework.
Mathematical Optimization: A system that uses machine learning and artificial intelligence to quickly and accurately predict outcomes from thousands of potential policy scenarios.
Rating Scale: Describes how much preference is given to candidates within each attribute.
Weights: Reflect the relative importance or priority of each attribute toward our overall goal of organ allocation. Combined with the ratings scale and each candidate’s information, this results in an overall composite score for prioritizing candidates.