2 What p roblem will the proposal solve Insufficient livers available for all of the candidates who would benefit from liver transplant Logistical complications associated with using split livers at two separate programs can impede split liver transplantation ID: 1003533
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1. 1Split Liver VarianceLiver and Intestinal Transplantation Committee
2. 2What problem will the proposal solve? Insufficient livers available for all of the candidates who would benefit from liver transplantLogistical complications associated with using split livers at two separate programs can impede split liver transplantationExisting split liver variance is not often used
3. A new varianceParticipating transplant hospitals could transplant both segments of a split liver into candidates at their own program or affiliated programs3-year time limitCan use either segment for the first candidateMust offer second segment to Status 1 and MELD/PELD >32 within 500nm firstWhat is the proposed solution?3
4. Existing VarianceProposed VarianceMust use right hemiliver or trisegment firstCan use either side firstDo not need to offer the remaining segment firstMust first offer the remaining segment to Status 1 and MELD>32 within 500nm firstCan participate by DSA or regionIndividual centers can participate4
5. Interested programs can apply to the OPTN to join the open varianceHow will members implement this proposal?5
6. Review and approve applicationsMonitor and evaluate changes in how often livers are split and how those are usedEnsure variance expires in 3 years How will the OPTN implement this proposal?6
7. Should this variance only be available to region eight, or should it be available to other OPTN/UNOS members that would like to participate?Would your program be interested in participating in this variance? Is the Committee seeking feedback7
8. Questions?8
9. Less than 1.5% of donor livers are splitOnly 4 livers split under existing varianceSupporting Evidence9Age of Primary RecipientAge of Secondary RecipientAllTransplant Year20102011201220132014201520162017N%N%N%N%N%N%N%N%N%PediatricPediatric418.6112.5610.0813.1811.646.723.644.989.6Adult43891.4787.55490.05386.96188.45693.35496.47895.17590.4Total479100.08100.060100.061100.069100.060100.056100.082100.083100.0AdultPediatric1027.01100.0233.3120.0466.700.0120.0116.700.0Adult2773.000.0466.7480.0233.33100.0480.0583.35100.0Total37100.01100.06100.05100.06100.03100.05100.06100.05100.0
10. 500nm Radius Circles Around Donor Hospitals10
11. Transplant YearN%201412616.2201512215.7201617622.6201717622.6201817822.9Total778100.0Deceased Donor Split Liver Transplants in the U.S., During January 1, 2014 to December 31, 2018, Stratified by Transplant Year11
12. 12Transplant Recipient OPTN RegionTransplant Year20142015201620172018TotalNColumn %NColumn %NColumn %NColumn %NColumn %NColumn %164.886.62212.5169.163.4587.522620.6129.82815.93218.22212.412015.4364.864.952.842.3147.9354.5443.2129.821.1126.821.1324.152822.23226.23620.53218.24424.717222.1600.021.621.100.042.281.07107.91814.81810.2148.0105.6709.0864.800.0126.884.563.4324.192015.91411.51810.22011.42413.59612.310129.5108.2169.12413.62614.68811.31186.386.6179.7148.02011.2678.6Total126100.0122100.0176100.0176100.0178100.0778100.0Deceased Donor Split Liver Transplants in the U.S., During January 1, 2014 to December 31, 2018, by Year and OPTN Region