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Liver and Intestinal Organ Transplantation Committee

Explore the revised HCC exception eligibility criteria and its impact on organ transplantation. Analyze geographic variations and distribution models for equitable allocation. Contact committee chair for questions.

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Liver and Intestinal Organ Transplantation Committee

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  1. Liver and Intestinal Organ Transplantation Committee Spring 2016

  2. Policy Implementation Dates

  3. Committee Projects HCC Public Comment: Aug 2016 (est) Revise exception eligibility criteria • NLRB Public Comment: Jan 2016 • Continued development: • Revise initial exception score assignment • Eliminate automatic increases upon extension

  4. Revise HCC Exception Eligibility • Consider revising standard exception eligibility criteria to include candidates beyond Milan criteria and downstaged • Consider whether these candidates should not be eligible for exception scores: • Have a single, small, well-treated tumor, until evidence of recurrence • Have an AFP >1,000, until AFP is <500

  5. Redistricting • New SRTR requests based on feedback received at June 2015 Forum • October 2015: Additional analysis to determine impact of MELD/PELD exceptions on previously modeled scenarios • Spring 2016: Model 500-mile concentric circle distribution based on donor hospital location • Proximity points for local candidates at radii of 150 and 250 miles

  6. Impact of MELD Exceptions: Results • Confirmed that distribution becomes more equitable as number of districts decreases • Recipients with no exception points: variation highest of all, decreases in all scenarios • 4-district scenarios offer largest reduction in variance, but 8-district also improvement over current policy

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

  8. Variance in Median Allocation MELD/PELD at Transplant by DSA, All Transplants

  9. Variance in Median MELD/PELD at Transplant by DSA, Recipients with No Exception Points

  10. Geographic Variation in Median Allocation MELD/PELD at Transplant by DSA, All Transplants

  11. Geographic Variation in Median MELD/PELD at Transplant by DSA, Recipients with No Exception Points

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