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Liver and Intestinal Organ Transplantation Committee

Liver and Intestinal Organ Transplantation Committee. Spring 2016. Policy Implementation Dates. Committee Projects. HCC Public Comment: Aug 2016 (est) Revise exception eligibility criteria. NLRB Public Comment: Jan 2016 Continued development: Revise initial exception score assignment

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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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