Changes in the Adult Liver-Intestine Allocation Policy

The new OPTN policy for allocation of combined liver-intestine candidates was implemented on June 18th 2013. Based on the new rules all the candidates listed for liver-intestine may be offered nationally after local liver candidates with a MELD/PELD scores of 29 or higher (table 1). The real impact of these changes is not clear yet, but we expect to have some preliminary data soon. Continuous improvements in the allocation system for combined liver-intestine are fundamental to achieve better results and to decrease mortality on the waiting list. The main challenge for UNOS, intestinal transplant centers and for the Intestinal Transplant Association remains to provide excellent organs in a reasonable time without unduly compromising access to organs for liver only candidates.

Table 1: Adult Donor Liver Allocation Algorithm (Modified from UNOS/OPTN)


Combined Local and Regional

1. Status 1A candidates in descending point order
2. Status 1B candidates in descending order


Local and Regional

3. Candidates with MELD/PELD Scores >=35 in descending order of mortality risk (MELD) scores, with Local candidates ranked above Regional candidates at each level of MELD score



4. Candidates with MELD/PELD Scores 29-34 in descending order of mortality risk scores



5. Liver-Intestine Candidates in descending order of Status and mortality risk scores



6. Candidates with MELD/PELD Scores 15-28 in descending order of mortality risk scores



7. Candidates with MELD/PELD Scores 15-34 in descending order of mortality risk scores


* Not showing the algorithm for patients with MELD < 15