OPTN Policies, Policy 9: Allocation of Livers and Liver-Intestines

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9.1.B Pediatric Status 1A Requirements To assign a candidate pediatric status 1A, the candidate’s transplant hospital must submit a Liver Status 1A Justification Form to the OPTN. A candidate is not assigned pediatric status 1A until this form is submitted. The candidate’s transplant program may assign the candidate pediatric status 1A if all the following conditions are met: 1. The candidate is less than 18 years old at the time of registration. This includes candidates less than 18 years old at the time of registration, who remain on the waiting list after turning 18 years old, but does not include candidates removed from the waiting list at any time who then return to the waiting list after turning 18 years old. 2. The candidate has at least one of the following conditions: a. Fulminant liver failure, defined as the onset of hepatic encephalopathy within 56 days of the first signs or symptoms of liver disease. In addition, the candidate: i. Must not have a pre-existing diagnosis of liver disease. For purposes of this section, any diagnoses of liver disease that occurred prior to a subsequent liver transplant do not constitute pre-existing liver disease. ii. Must meet at least one of the following criteria: 1. Is ventilator dependent 2. Requires dialysis, continuous veno-venous hemofiltration (CVVH), or continuous veno-venous hemodialysis (CVVHD 3. Has an international normalized ratio (INR) greater than 2.0 Page 168 b. Diagnosis of primary non-function of a transplanted liver within 7 days of transplant, evidenced by at least two of the following: i. Alanine aminotransferase (ALT) greater than or equal to 2,000 U/L ii. INR greater than or equal to 2.5 iii. Total bilirubin greater than or equal to 10 mg/dL iv. Acidosis, defined as one of the following: • Arterial pH less than or equal to 7.30 • Venous pH less than or equal to 7.25 • Lactate greater than or equal to 4 mmol/L All laboratory results reported for any tests required for the primary non-function of a transplanted liver diagnosis above must be from the same blood draw taken between 24 hours and 7 days after the transplant. c. Diagnosis of hepatic artery thrombosis (HAT) in a transplanted liver within 14 days of transplant d. Acute decompensated Wilson’s disease

Ссылаются нормы: PediatricStatus1AFulminant, SeverityDialysis, SeverityInrStrict2023, SeverityVentilator

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9.1.C Pediatric Status 1B Requirements To assign a candidate pediatric status 1B, the candidate’s transplant hospital must submit a Liver Status 1B Justification Form to the OPTN. A candidate is not registered as status 1B until this form is submitted. The candidate’s transplant program may assign the candidate pediatric status 1B if all the following conditions are met: 1. The candidate is less than 18 years old at the time of registration. This includes candidates less than 18 years old at the time of registration, who remain on the waiting list after turning 18 years old, but does not include candidates removed from the waiting list at any time who then return to the waiting list after turning 18 years old. 2. The candidate has one of the following conditions: a. The candidate has a biopsy-proven hepatoblastoma without evidence of metastatic disease. b. The candidate has an organic acidemia or urea cycle defect and an approved MELD or PELD exception meeting standard criteria for metabolic disease for at least 30 days. Page 169 c. Chronic liver disease with a calculated MELD or PELD greater than 25, and has at least one of the following criteria: i. Is on a mechanical ventilator ii. Has gastrointestinal bleeding requiring at least 30 mL/kg of red blood cell replacement within the previous 24 hours iii. Has renal failure or renal insufficiency requiring dialysis, continuous venovenous hemofiltration (CVVH), or continuous veno-venous hemodialysis (CVVHD) iv. Has a Glasgow coma score (GCS) less than 10 within 48 hours before the status 1B assignment or extension. d. Chronic liver disease and is a combined liver-intestine candidate with an adjusted MELD or PELD score greater than 25 according to Policy 9.1.F: Liver-Intestine Candidates and has at least one of the following criteria: v. Is on a mechanical ventilator vi. Has gastrointestinal bleeding requiring at least 10 mL/kg of red blood cell replacement within the previous 24 hours vii. Has renal failure or renal insufficiency requiring dialysis, continuous veno-venous hemofiltration (CVVH), or continuous veno-venous hemodialysis (CVVHD) viii. Has a Glasgow coma score (GCS) less than 10 within 48 hours before the status 1B assignment or extension.

Ссылаются нормы: ComplicationBleeding2023, ComplicationGlasgow2023, ComplicationRenal, ComplicationVentilator, PediatricStatus1BChronic2023

en · official · sha256:dd414f1f576f157d5b7c6281b9249f731507eaeb8e3dfad1afee89b0df7ae2abEN

9.1.B Acute decompensated Wilson’s disease Pediatric Status 1A Requirements To assign a candidate pediatric status 1A, the candidate’s transplant hospital must submit a Liver Status 1A Justification Form to the OPTN. A candidate is not assigned pediatric status 1A until this form is submitted. The candidate’s transplant program may assign the candidate pediatric status 1A if all the following conditions are met: 1. The candidate is less than 18 years old at the time of registration. This includes candidates less than 18 years old at the time of registration, who remain on the waiting list after turning 18 years old, but does not include candidates removed from the waiting list at any time who then return to the waiting list after turning 18 years old. 2. The candidate has at least one of the following conditions: a. Fulminant liver failure and the candidate: i. Must not have a pre-existing diagnosis of liver disease. For purposes of this section, any diagnoses of liver disease that occurred prior to a subsequent liver transplant do not constitute pre-existing liver disease. ii. Must meet at least one of the following criteria: 1. Is ventilator dependent 2. Requires dialysis, continuous veno-venous hemofiltration (CVVH), or continuous veno-venous hemodialysis (CVVHD) 3. Has an international normalized ratio (INR) greater than or equal to 1.5 and less than 2.0 and a diagnosis of hepatic encephalopathy within 56 days of the first signs or symptoms of liver disease 4. Has an INR greater than or equal to 2.0 Page 184 b. Diagnosis of primary non-function of a transplanted liver within 7 days of transplant, evidenced by at least two of the following: i. Alanine aminotransferase (ALT) greater than or equal to 2,000 U/L ii. INR greater than or equal to 2.5 iii. Total bilirubin greater than or equal to 10 mg/dL iv. Acidosis, defined as one of the following: • Arterial pH less than or equal to 7.30 • Venous pH less than or equal to 7.25 • Lactate greater than or equal to 4 mmol/L All laboratory results reported for any tests required for the primary non-function of a transplanted liver diagnosis above must be from the same blood draw taken between 24 hours and 7 days after the transplant. c. Diagnosis of hepatic artery thrombosis (HAT) in a transplanted liver within 14 days of transplant d. Acute decompensated Wilson’s disease

Ссылаются нормы: PediatricStatus1AFulminant, SeverityDialysis, SeverityInrAtLeastTwo2025, SeverityInrBandWithEncephalopathy2025, SeverityVentilator

en · official · sha256:1dbf672cbe7c8b7b20319bc2825d10b50c896fc4a6f63e5fdf96d521856bc584EN

9.1.C Pediatric Status 1B Requirements To assign a candidate pediatric status 1B, the candidate’s transplant hospital must submit a Liver Status 1B Justification Form to the OPTN. A candidate is not registered as status 1B until this form is submitted. The candidate’s transplant program may assign the candidate pediatric status 1B if all the following conditions are met: 1. The candidate is less than 18 years old at the time of registration. This includes candidates less than 18 years old at the time of registration, who remain on the waiting list after turning 18 years old, but does not include candidates removed from the waiting list at any time who then return to the waiting list after turning 18 years old. 2. The candidate has one of the following conditions: a. The candidate has a biopsy-proven hepatoblastoma without evidence of metastatic disease. b. The candidate has an organic acidemia or urea cycle defect and an approved MELD or PELD exception meeting standard criteria for metabolic disease for at least 30 days. c. Chronic liver disease and meets at least one of the following criteria due to complications of chronic liver disease: i. Is on a mechanical ventilator ii. Has gastrointestinal bleeding requiring red blood cell replacement of at least 30 mL/kg within the previous 96 hours or 20 mL/kg within the previous 24 hours iii. Has renal failure or renal insufficiency requiring dialysis, continuous venovenous hemofiltration (CVVH), or continuous veno-venous hemodialysis (CVVHD) Page 185 d. Chronic liver disease and is a combined liver-intestine candidate and meets at least one of the following criteria due to complications of chronic liver disease: i. Is on a mechanical ventilator ii. Has gastrointestinal bleeding requiring at least 10 mL/kg of red blood cell replacement within the previous 24 hours iii. Has renal failure or renal insufficiency requiring dialysis, continuous venovenous hemofiltration (CVVH), or continuous veno-venous hemodialysis (CVVHD)

Ссылаются нормы: ComplicationBleeding24h2025, ComplicationBleeding96h2025, ComplicationRenal, ComplicationVentilator, PediatricStatus1BChronic2025

en · official · sha256:a0f054d2ce6ed5f681e2cc104eb5fab7f23be0b9ff0477c8415963471c42aea3EN

9.1.D MELD Score Candidates who are at least 18 years old at the time of registration receive a MELD score equal to: MELD = 1.33 (if female) + [4.56 x loge(bilirubin)] + [0.82 x (137-sodium)] – [0.24 x (137-sodium) x loge(bilirubin)] + [9.09 x loge(INR)] + [11.14 x loge(creatinine)] + [1.85 x (3.5-albumin)] – [1.83 x (3.5 – albumin) x loge(creatinine)] + 6 Candidates who are currently at least 12 years old and were less than 18 years old at the time of registration receive a MELD score equal to: MELD = [4.56 x loge(bilirubin)] + [0.82 x (137-sodium)] – [0.24 x (137-sodium) x loge(bilirubin)] + [9.09 x loge(INR)] + [11.14 x loge(creatinine)] + [1.85 x (3.5-albumin)] – [1.83 x (3.5 – albumin) x loge(creatinine)] + 7.33 Bilirubin, INR, and creatinine values less than 1.0 will be set to 1.0 when calculating a candidate’s MELD score. The following candidates will receive a creatinine value of 3.0 mg/dL when calculating a candidate’s MELD score: • • • Candidates with a creatinine value greater than 3.0 mg/dL Candidates who received two or more dialysis treatments within the 7 days prior to the serum creatinine test Candidates who received 24 hours of continuous veno-venous hemodialysis (CVVHD) within the 7 days prior to the serum creatinine test Sodium values less than 125 mmol/L will be set to 125 mmol/L, and values greater than 137 mmol/L will be set to 137 mmol/L. Albumin values less than 1.5 g/dL will be set to 1.5 g/dL, and values greater than 3.5 g/dL will be set to 3.5 g/dL. The minimum MELD score is 6. The maximum MELD score is 40. The MELD score derived from this calculation will be rounded to the nearest whole number. Page 186

Ссылаются нормы: AlbuminUsed, BilirubinUsed, CreatinineCappedByCvvhd, CreatinineCappedByDialysis, CreatinineUsedFromDialysis, CreatinineUsedFromValue, InrUsed, MeldAdolescent, MeldAdultFemale, MeldAdultMale, MeldScoreBounded, MeldSharedTerms, SodiumUsed