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Adult MELD Exception Guidance

Adult MELD Exception Guidance. Liver and Intestinal Organ Transplantation Committee Fall 2016. What problem will the proposal solve?. Regional differences in exception submission and approval practices Range of exceptions among regions: 32%-57% Non-standardized exception transplants: 3%-21%

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Adult MELD Exception Guidance

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  1. Adult MELD Exception Guidance Liver and Intestinal Organ Transplantation Committee Fall 2016

  2. What problem will the proposal solve? • Regional differences in exception submission and approval practices • Range of exceptions among regions: 32%-57% • Non-standardized exception transplants: 3%-21% • Exception candidates drop off the waitlist at lower rates and are transplanted at higher rates than candidates with equivalent calculated MELD • NLRB will promote consistent, evidence-based review of exception requests

  3. National Liver Review Board (NLRB) Spring 2016 Fall 2016 Spring 2017

  4. What are the proposed solutions? • Guidance to evaluate exception requests for adult candidates • Supplement existing guidance for NET, PLD, PSC, POPH • Developed based on review of recent types of requests • To support recommendation for exception: requires measurable end-point, such as waitlist drop-out or increased risk of mortality, not reflected in the calculated MELD score • Reviewed evidence in peer-reviewed literature and developed consensus recommendation

  5. How will members implement this proposal? • If approved, NLRB members would consult this resource when reviewing adult MELD exception requests • Liver programs should consider this resource when submitting requests • No additional data collection • OPTN/UNOS will provide templates for programs to use when submitting requests

  6. Questions? Ryutaro Hirose, MD Committee Chair ryutaro.hirose@ucsf.edu Christine Flavin, MPH Committee Liaison christine.flavin@unos.org

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