The new system replaces the use of decades-old geographic boundaries of 58 donation service areas (DSAs) and 11 transplant regions. It emphasizes the medical urgency of liver transplant candidates and the distance between the donor hospital and transplant hospitals.
Livers from all deceased donors will first be offered to the most urgent liver transplant candidates (Status 1A and 1B) listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital. Following offers to the most urgent candidates, livers from adult donors will be offered to candidates at hospitals within distances of 150, 250 and 500 nautical miles of the donor hospital. These offers are grouped by medical urgency.
The OPTN Board of Directors approved the policy in December 2018. It was implemented briefly in May 2019, then reverted to the prior system of DSAs and regions while a federal court considered a legal challenge to the new system. A court ruling issued Jan. 16, 2020, allowed the re-implementation to proceed.
Statistical modeling of the new policy projects that it will save more lives, with fewer patients dying while waiting for a liver transplant. It also makes the system fairer by providing more equitable access to a transplant based on medical need for the benefit of all patients. The policy also is expected to increase the number of liver transplants for children under the age of 18 by increasing their priority for organs from donors who are also younger than 18. The benefits of the system are projected to have similar effects across various socioeconomic groups and population types, such as urban, rural and suburban.
The policy was developed by transplant and donation experts, recipients and donor families from around the country, with consideration of more than 1,200 public comments.
The new policy takes effect at a time of sustained increase in organ donation and transplantation in the United States. Nearly 40,000 total transplants were performed nationwide in 2019, setting an annual record for the seventh year in a row. Of that total, 8,372 liver transplants were performed involving deceased donors, an increase of 6.7 percent over the 2018 total.