Organ Procurement and Transplantation Assessing Current Policies and the Potential Impact of the DHHS Final Rule (1999) / Chapter Skim
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Appendix C: Current Liver Allocation Policies
Appendix C: Current Liver Allocation Policies
Pages 183-198
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From page 183... ...
Following Status 1, livers will be offered for patients with an assigned status of 2A in descending point sequence with the patient having the highest number of points receiving the highest priority before being offered for patients listed in less urgent statuses. Following Status 2A, livers will be offered for patients with an assigned status of 2B in descending point sequence with the patient having the highest number of points receiving the highest priority.
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From page 184... ...
Status 2B patients in descending point order 4. Status 3 patients in descending point order The liver must be transplanted into the original designee or be released back to the donor center or to the I3NOS Organ Center for distribution.
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From page 185... ...
Livers will be offered for patients with an assigned status of 1 in descend~ng point sequence with the patient having the highest number of points receiving the highest priority before being offered for patients listed in other status categories. Following Status 1, livers will be offered for patients with an assigned status of 2A in descending point sequence with the patient having the highest number of points receiving the highest priority before being offered for patients listed in less urgent statuses.
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From page 186... ...
The 'time of waiting' begins when a patient is initially placed on the UNOS Patient Waiting List. Ten points will be accrued by the patient waiting for the longest period for a liver transplant and proportionately fewer points will be accrued by Nose patients with shorter tenure.
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From page 187... ...
The justification must include a rationale for incorporating the exceptional case as part of the criteria. A report of the decision of the Regional Review Board and the basis for it shall be forwarded to UNOS for review by the Liver and Intestinal Organ Transplantation and Membership and Professional Standards Comm~ttees to determine consistency in application among and within regions and continued appropriateness of the patient status criteria.
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From page 188... ...
UNOS shall notify the listing transplant center of the need to reassess a Status 2B patient 30 days prior to the 6-month deadline. If a completed Liver Status 2B Justification Form is not received by UNOS 6 months from the date the
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From page 189... ...
An upgrade to Status 2A shall be reviewed by the applicable UNOS Regional Review Board and is intended for the exceptional patient with chronic liver disease who meets the criteria for Status 2B and whose clinical condition acutely deteriorates as defined by the following criteria. A patient listed as Status 2A is in the hospital's critical care unit due to chronic liver failure with a life expectancy without a liver transplant of less than 7 days, and with a long-term prognosis with a successful liver transplant equivalent to that of a patient with fulminant liver failure.
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From page 190... ...
If a completed Liver Status 2A Justification Form is not received by UNOS within 24 hours of the Status 2A liver candidate registration on the waiting list, the candidate shall be reassigned to a Status 2B. A relisting request to continue a Status 2A listing for the same patient waiting on that specific transplant beyond 14 days accumulated time will result in an onsite review of all local Status 2 liver patient listings.
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From page 191... ...
The justification must include a rationale for incorporating the exceptional case as part of the criteria. A report of the decision of the Regional Review Board and the basis for it shall be forwarded to UNOS for review by the Liver and Intestinal Organ Transplantation and Membership and Professional Standards committees to determine consistency in application among and within regions and continued appropriateness of the patient status criteria.
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From page 192... ...
an ascitic fluid white blood cell count with greater than 300 polymorphonuclear cells per milliliter, or a total of 500 white blood cells per milliliter. Refractory Ascites/Hepato-Hydrothorax; Severe persistent ascites or hepatohydrothorax defined as any one of the following: unresponsive to diuretic and salt restriction therapy leading to respiratory distress, or requiring supplemental tube feeding, or requiring parenteral nutrition, or requiring paracenteses.
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From page 193... ...
UNOS shall notify the listing transplant center of the need to reassess a Status 2B patient 30 days prior to the 6-month deadline. If a completed Liver Status 2B Justification Form is not received by IJNOS 6 months from the date the patient is initially listed as a Status 2B and every 6 months thereafter, the patient shall be re-assigned to a Status 3.
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From page 194... ...
If a completed Liver Status 1 Justification Form is not received by UNOS within 24 hours of the Status 1 liver candidate registration on He waiting list, the candidate shall be reassigned to a Status 2B. A relisting request to continue a Status 1 listing for the same patient waiting on that specific transplant beyond 14 days accumulated time will result in an on-site review of all local Status 2 and 1 liver patient listings.
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From page 195... ...
A patient with HCC at Stage III or higher may continue to be considered a liver transplant candidate in accordance with each center's own specific policy or philosophy, but the patient must be listed as a Status 3, unless the candidate meets the other criteria specified for Status 2B or 2A in Policy 3.6.4. In addition, a patient with HCC must be reviewed by the applicable UNOS liver regional review board prior to being upgraded to a Status 2B.
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From page 196... ...
A pediatric patient with non-metastatic hepatoblastoma who is otherwise a suitable candidate for liver transplantation may be registered as a Status 2B on the UNOS Patient Waiting List. 3.6.4.5 Status Verification for Potential Liver Recipients.
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From page 197... ...
3.6.7 UNOS Organ Center Assistance with Liver Allocation. It is recommended that the UNOS Organ Center be notified when a liver donor is identified and provided all clinical information that is necessary to offer the liver to potential recipients on the UNOS Patient Waiting List.
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From page 198... ...
A transplant center that accepts a liver for segmental transplantation may allocate the remaining segment to any medically appropriate candidate on the I] NOS Patient Waiting List.
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