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Implementation of a national liver review board for exception requests in the united states: A two-year monitoring report.

Implementation of a national liver review board for exception requests in the united states: A two-year monitoring report. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Kwong, A. J., Foutz, J., Cafarella, M., Biggins, S. W., Shah, N. D., Eason, J., Perito, E. R., Pomposelli, J., Trotter, J. 2023

Abstract

The exception point system for liver allocation in the United States allows for additional waitlist priority for candidates where the Model for End-Stage Liver Disease or Pediatric End-Stage Liver Disease does not effectively represent their urgency or need for transplant. In May 2019, the review process for liver exception cases transitioned from 11 Regional Review Boards (RRBs) to one National Liver Review Board (NLRB), intended to increase consistency nationwide, improve efficiency, and balance transplant access for candidates with and without exception scores. This report provides a review of liver exception request and review practices, waitlist outcomes, and transplant activity in the first two years after implementation of the NLRB and Acuity Circle-based distribution in the United States.We compared initial and extension exception request forms submitted from 05/13/2017 to 05/13/2019 (pre-policy or RRB era), to the period from 02/04/2020 to 02/03/2022 (post-policy or NLRB era). During this time, the NLRB reviewed 10,083 initial exception requests and 12,686 extension requests. Notable post-policy highlights include: (1) increase in the proportion of initial and extension requests that were automatically approved instead of manually reviewed; (2) decrease in the overall approval rates of initial exception requests (87.8% for adult HCC, 64.3% for adult other diagnoses, and 71.5% for pediatric); and (3) reduction in the time from exception request submission to adjudication, to a median of 3.73 days. The proportions of waitlist registration and deceased donor liver transplants for patients with exception scores decreased, and waitlist outcomes between patients with and without exception scores are now comparable.Implementation of the NLRB improved efficiency, reduced case workloads, and standardized criteria for exception cases, with similar waitlist outcomes between patients with and without exception scores and improved equity in terms of access to liver transplant.

View details for DOI 10.1097/LVT.0000000000000248

View details for PubMedID 37639285