Resolution 8 Liver and Intestinal Organ Transplantation Committee David Mulligan MD Chair Share 35 policy implemented 06182013 with the goal to direct livers to those most at risk of death ID: 927435
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Slide1
Proposal to
Cap the HCC Exception Score at 34
(Resolution 8)
Liver and Intestinal
Organ Transplantation Committee
David Mulligan, MD Chair
Slide2Share 35 policy implemented 06/18/2013 with the goal to direct livers to those most at risk of death
BUT livers are being offered regionally to HCC 35+ candidatesThese candidates have much lower risk of waiting list dropoutContrary to the intent of Share 35
The Problem
Slide3Strategic Plan
Goal 2: To Increase
Access to Transplants
Better prioritize those candidates most in need of liver transplantation
Slide4Goal of the Proposal
Give candidates with calculated MELD/PELD scores of 35 and higher a better opportunity to receive regional offers under the new
policy
Slide5E
xclude
patients with HCC exceptions
who have a lower
risk of death or rate of drop out from regional sharing under Share
35
How the Proposal will Achieve its Goal
Slide6MELD/PELD Score 35+ candidate have high mortality risk, similar to Status 1 (Sharma, et al)
HCC exception candidates have lower waiting list death/dropout (Washburn, et al, Massie, et al)Number of HCC exception scores 35+ increasing
Only 6 in
2010, 41
cases in 2013
Many as “Other, specify” with HCC criteria entered into narrative
Cap HCC Supporting Evidence
Slide7Candidates with HCC exceptions receive increases every 3 months
Most patients treated (90%), many with stable tumorsCapped candidates will still receive priority for local offersMay petition the RRB if need for higher priority is demonstrated
Cap HCC Supporting Evidence
Slide8Public Comment:
Proposal to Cap HCC Exception Score received 35 responses. Of these, 25 (71.43%) supported the proposal, 6 (17.14%) opposed the proposal, and 4 (11.43%) had no opinion. Of the 31 responses that included an opinion, 25 (80.65%) supported the proposal and 6 (19.35%) opposed the proposal.Regional Responses:
Approved by all Regions
HCC
Subcommittee
Recommendation:
Forward to the Board without substantial post public comment changes.
Committee unanimously voted in support: 15 in favor: 0 opposed: 0 abstentions
Public Comment
Slide9Overall Project Impact
1,020/10,680
1,215/17,885
Slide10RESOLVED
, that Policies 9.3.G.vi (Extensions of HCC Exceptions) are modified as set forth below, effective pending programming and notice to OPTN membership.9.3.G.vi
Extensions of HCC Exceptions
A candidate will receive additional MELD or PELD points equivalent to a 10 percentage point increase in the candidate’s mortality risk every three months after receiving an HCC exception until the candidate receives a transplant or is unsuitable for transplantation based on the candidate’s HCC progression. The HCC exception score will be capped at 34. Upon implementation, candidates with HCC exception scores greater than 34 will receive a score of 34 for their remaining HCC exception extensions. Candidates with scores greater than 34 at the time of implementation may be referred to the RRB if they demonstrate the need for higher priority
.
RESOLUTION 8, Page 17
Slide11David C. Mulligan, MD
Committee ChairDavid.Mulligan@yale.edu
Ashley Archer-Hayes, MAS
Committee Liaison
Ashley.Archer-Hayes@unos.org
Thank you for your consideration.
Questions
?