MELD Exception Scores During NLRB Transition
This proposal addresses the disparity in MELD scores at transplant hospitals within the same DSA and offers a solution by awarding exception points relative to MMaT by DSA during a transition period. It aims to provide equal opportunities for exception patients and streamline the allocation process.
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Presentation Transcript
MELD Exception Scores During NLRB Transition Executive Committee 1
What problem will the proposal solve? Circle-based median MELD at transplant (MMaT) would result in some transplant hospitals in the same DSA with different MMaTs While allocation is still based on DSA and region, this would disadvantage certain exception patients 2
What is the proposed solution? Award exception points relative to MMaT by DSA The award of exception points relative to MMaT by DSA will only be used during this ~1 month transition period (ending April 30), while DSAs are still used as units of distribution. After the transition period, MMaT within 250nm will be used according to the liver policy approved in December 2018 (Acuity Circles). 3
Other solutions considered Delay implementation of NLRB so that there is no transition period Eliminates transition problem, but uses some exception scores assigned in the old system while allocating under Acuity Circles. National MMaT during the transition period Treats everyone the same, but doesn t help candidate in areas that have less access Manually adjust MMaT for the affected transplant hospitals Solves for the affected centers, but treats candidates at a small subset of centers differently Leave as MMaT/250 during the transition period. (Current Board approved) Leaves the candidates in the 4 affected DSAs on unequal footing during the transition 4
How will the OPTN implement this proposal? Provide updated MMaT values before implementation Assign exception scores relative to the MMaT in the DSA during the transition When the ~1-month transition period is over (April 30), and MMaT in the 250nm circle and Acuity Circles are implemented, the candidates scores will be converted, and all MMaT-based exception scores will be changed at the same time. 5
Is the Committee seeking feedback? Should exceptions scores assigned prior to implementation of the NLRB be converted when the new allocation system is implemented? Transition period: about 1/3 of all existing exceptions will be due for extension, and will be converted to scores based on MMaT within 250NM when Acuity Circles takes effect After transition: remaining 2/3 of exceptions would still have scores assigned under the regional review board system These are the scores that could potentially be converted 6
