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A candidate is not assigned pediatric status 1A until\nthis form is submitted.\nThe candidate’s transplant program may assign the candidate pediatric status 1A if all the\nfollowing conditions are met:\n1. The candidate is less than 18 years old at the time of registration. This includes candidates\nless than 18 years old at the time of registration, who remain on the waiting list after turning\n18 years old, but does not include candidates removed from the waiting list at any time who\nthen return to the waiting list after turning 18 years old.\n2. The candidate has at least one of the following conditions:\na. Fulminant liver failure, defined as the onset of hepatic encephalopathy within 56 days of\nthe first signs or symptoms of liver disease. In addition, the candidate:\ni. Must not have a pre-existing diagnosis of liver disease. For purposes of this section,\nany diagnoses of liver disease that occurred prior to a subsequent liver transplant\ndo not constitute pre-existing liver disease.\nii. Must meet at least one of the following criteria:\n1. Is ventilator dependent\n2. Requires dialysis, continuous veno-venous hemofiltration (CVVH), or\ncontinuous veno-venous hemodialysis (CVVHD\n3. Has an international normalized ratio (INR) greater than 2.0\nPage 168\nb. Diagnosis of primary non-function of a transplanted liver within 7 days of transplant,\nevidenced by at least two of the following:\ni. Alanine aminotransferase (ALT) greater than or equal to 2,000 U/L\nii. INR greater than or equal to 2.5\niii. Total bilirubin greater than or equal to 10 mg/dL\niv. Acidosis, defined as one of the following:\n• Arterial pH less than or equal to 7.30\n• Venous pH less than or equal to 7.25\n• Lactate greater than or equal to 4 mmol/L\nAll laboratory results reported for any tests required for the primary non-function of a\ntransplanted liver diagnosis above must be from the same blood draw taken between\n24 hours and 7 days after the transplant.\nc. Diagnosis of hepatic artery thrombosis (HAT) in a transplanted liver within 14 days of\ntransplant\nd. Acute decompensated Wilson’s disease"}]},{"contentHash":"sha256:9e5d5ba122cba39e9fdbcba07b77a143c4c5be690264f3ccdfebf1f67fa11f3e","edition":"urn:us:optn:clir:liver-status#OPTN_POLICIES_20230316","fragmentKind":"section","id":"urn:us:optn:clir:liver-status#LS_2023_ART9_1C","kind":"fragment","labels":[{"language":"en","status":"official","text":"Policy 9.1.C: Pediatric Status 1B Requirements (edition of 16 March 2023)"}],"locator":"article/9_1C","package":"urn:us:optn:clir:liver-status","texts":[{"contentHash":"sha256:352b3c232af809b48e77403c477efb1f605cf2fabdc8383d86b03e31ec2fdaea","language":"en","status":"official","text":"9.1.C\nPediatric Status 1B Requirements\nTo assign a candidate pediatric status 1B, the candidate’s transplant hospital must submit a Liver\nStatus 1B Justification Form to the OPTN. A candidate is not registered as status 1B until this\nform is submitted.\nThe candidate’s transplant program may assign the candidate pediatric status 1B if all the\nfollowing conditions are met:\n1. The candidate is less than 18 years old at the time of registration. This includes candidates\nless than 18 years old at the time of registration, who remain on the waiting list after\nturning 18 years old, but does not include candidates removed from the waiting list at any\ntime who then return to the waiting list after turning 18 years old.\n2. The candidate has one of the following conditions:\na. The candidate has a biopsy-proven hepatoblastoma without evidence of metastatic\ndisease.\nb. The candidate has an organic acidemia or urea cycle defect and an approved MELD or\nPELD exception meeting standard criteria for metabolic disease for at least 30 days.\nPage 169\nc. Chronic liver disease with a calculated MELD or PELD greater than 25, and has at least\none of the following criteria:\ni.\nIs on a mechanical ventilator\nii.\nHas gastrointestinal bleeding requiring at least 30 mL/kg of red blood cell\nreplacement within the previous 24 hours\niii.\nHas renal failure or renal insufficiency requiring dialysis, continuous venovenous hemofiltration (CVVH), or continuous veno-venous hemodialysis\n(CVVHD)\niv.\nHas a Glasgow coma score (GCS) less than 10 within 48 hours before the status\n1B assignment or extension.\nd. Chronic liver disease and is a combined liver-intestine candidate with an adjusted MELD\nor PELD score greater than 25 according to Policy 9.1.F: Liver-Intestine Candidates and\nhas at least one of the following criteria:\nv.\nIs on a mechanical ventilator\nvi.\nHas gastrointestinal bleeding requiring at least 10 mL/kg of red blood cell\nreplacement within the previous 24 hours\nvii.\nHas renal failure or renal insufficiency requiring dialysis, continuous veno-venous\nhemofiltration (CVVH), or continuous veno-venous hemodialysis (CVVHD)\nviii.\nHas a Glasgow coma score (GCS) less than 10 within 48 hours before the status\n1B assignment or extension."}]},{"contentHash":"sha256:2e942547e71d40a6fddb65572675c715acf95bd3f827a4e0fcaabd95ee2d4b94","edition":"urn:us:optn:clir:liver-status#OPTN_POLICIES_20251113","fragmentKind":"section","id":"urn:us:optn:clir:liver-status#LS_2025_ART9_1B","kind":"fragment","labels":[{"language":"en","status":"official","text":"Policy 9.1.B: Pediatric Status 1A Requirements (edition of 13 November 2025)"}],"locator":"article/9_1B","package":"urn:us:optn:clir:liver-status","texts":[{"contentHash":"sha256:dd414f1f576f157d5b7c6281b9249f731507eaeb8e3dfad1afee89b0df7ae2ab","language":"en","status":"official","text":"9.1.B\nAcute decompensated Wilson’s disease\nPediatric Status 1A Requirements\nTo assign a candidate pediatric status 1A, the candidate’s transplant hospital must submit a Liver\nStatus 1A Justification Form to the OPTN. A candidate is not assigned pediatric status 1A until\nthis form is submitted.\nThe candidate’s transplant program may assign the candidate pediatric status 1A if all the\nfollowing conditions are met:\n1. The candidate is less than 18 years old at the time of registration. This includes candidates\nless than 18 years old at the time of registration, who remain on the waiting list after turning\n18 years old, but does not include candidates removed from the waiting list at any time who\nthen return to the waiting list after turning 18 years old.\n2. The candidate has at least one of the following conditions:\na. Fulminant liver failure and the candidate:\ni. Must not have a pre-existing diagnosis of liver disease. For purposes of this section,\nany diagnoses of liver disease that occurred prior to a subsequent liver transplant\ndo not constitute pre-existing liver disease.\nii. Must meet at least one of the following criteria:\n1. Is ventilator dependent\n2. Requires dialysis, continuous veno-venous hemofiltration (CVVH), or\ncontinuous veno-venous hemodialysis (CVVHD)\n3. Has an international normalized ratio (INR) greater than or equal to 1.5 and\nless than 2.0 and a diagnosis of hepatic encephalopathy within 56 days of\nthe first signs or symptoms of liver disease\n4. Has an INR greater than or equal to 2.0\nPage 184\nb. Diagnosis of primary non-function of a transplanted liver within 7 days of transplant,\nevidenced by at least two of the following:\ni. Alanine aminotransferase (ALT) greater than or equal to 2,000 U/L\nii. INR greater than or equal to 2.5\niii. Total bilirubin greater than or equal to 10 mg/dL\niv. 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Acute decompensated Wilson’s disease"}]},{"contentHash":"sha256:237a20a4cb3a728f7f5ba5fd004b468f687eb59430a1a9417856f432f221cd95","edition":"urn:us:optn:clir:liver-status#OPTN_POLICIES_20251113","fragmentKind":"section","id":"urn:us:optn:clir:liver-status#LS_2025_ART9_1C","kind":"fragment","labels":[{"language":"en","status":"official","text":"Policy 9.1.C: Pediatric Status 1B Requirements (edition of 13 November 2025)"}],"locator":"article/9_1C","package":"urn:us:optn:clir:liver-status","texts":[{"contentHash":"sha256:1dbf672cbe7c8b7b20319bc2825d10b50c896fc4a6f63e5fdf96d521856bc584","language":"en","status":"official","text":"9.1.C\nPediatric Status 1B Requirements\nTo assign a candidate pediatric status 1B, the candidate’s transplant hospital must submit a Liver\nStatus 1B Justification Form to the OPTN. A candidate is not registered as status 1B until this\nform is submitted.\nThe candidate’s transplant program may assign the candidate pediatric status 1B if all the\nfollowing conditions are met:\n1. The candidate is less than 18 years old at the time of registration. This includes candidates\nless than 18 years old at the time of registration, who remain on the waiting list after\nturning 18 years old, but does not include candidates removed from the waiting list at any\ntime who then return to the waiting list after turning 18 years old.\n2. The candidate has one of the following conditions:\na. The candidate has a biopsy-proven hepatoblastoma without evidence of metastatic\ndisease.\nb. The candidate has an organic acidemia or urea cycle defect and an approved MELD or\nPELD exception meeting standard criteria for metabolic disease for at least 30 days.\nc. 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