The new National Liver Offering Scheme has now been introduced by NHS Blood and Transplant (NHSBT). This is the new system for liver transplant allocation and distribution.
The new offering scheme is a way of matching livers from deceased donors to patients on the liver transplant waiting list. The new scheme will match livers on a national basis rather than the regional basis in place at present and is expected to increase the number of life-years gained from transplanted livers and decrease the number of people who die on the waiting list.
The scheme also introduces a more objective way of matching organs to patients. Working with the Liver Advisory Group which includes representation from the British Liver Trust, NHSBT have developed a computing algorithm that uses both organ donor characteristics, and liver patient recipient characteristics, to match the donated liver to the recipient. In this way, the liver is allocated to the recipient who will receive the most benefit from a transplant from that particular donated liver.
This new scheme is expected to ensure that the right liver goes into the right recipient in a timely manner; increasing the number of patients’ lives that we’re able to save and improve. This new scheme uses a new scoring system called the Transplant Benefit Score (TBS).
How the new Transplant Benefit Score works
Priority will always be given to those patients on the ‘super urgent’ list (This list is for very sick patients who will not survive for long without a liver transplant). The super urgent list also includes patients with Hepatoblastoma and those waiting for a multi organ transplant.
If there is no patient on the super urgent list, or there is not a match, the available liver is then offered to patients on the Liver Transplant List with the highest Transplant Benefit Score (TBS). The highest ranked patient with the best match will be the first to be offered the liver. The final decision to accept the organ still lies with the patients transplant surgeon.
Livers that are proving more difficult to allocate will be offered broadly to make sure that the most number of lives are saved with the donor livers that are available.
How is a patients TBS Score worked out?
Before the new scheme was introduced patients with a liver disease were assessed on their need for a liver transplant based on their UKELD1 score (United Kingdom Model for End Stage Liver Disease). Clinicians calculated this score by looking at 4 different patient characteristics from the liver patient.
The new scheme is designed to be more in depth and takes into account 7 characteristics from the donor2; these donor characteristics are then ‘matched’ with 21 patient characteristics3. The patient with the best match will be shown at the top of the list and will have the highest Transplant Benefit Score (TBS).
The TBS predicts which patient will benefit the most from the transplanted liver – who will live the longest with the transplant, but also who can survive the longest on the list without receiving a transplant and is, therefore, able to safely wait a while longer before being offered a liver transplant. The scheme also includes
The TBS predicts which patient will benefit the most from the transplanted liver – who will live the longest with the transplant, but also who can survive the longest on the list without receiving a transplant and is, therefore, able to safely wait a while longer before being offered a liver transplant.
A small number of patients on the transplant wait list will not be suitable for assessment using the TBS and these patients will be allocated a proportion of organs equivalent to the number on the list (Proportional Allocation Pool). The Liver Transplant Patient Consortium has been consulted regularly in the last 5 years as the scheme has been developed.
An independent group has also been appointed to monitor the performance of the scheme and rapidly assess progress and any issues that may arise. Two patient representatives sit on this panel.
The change to the new scheme will be seamless for patients; transplant centres have already supplied the information needed to work out TBS for any liver being offered for transplantation. Centres will update patient information any time there is a change in circumstances, but must also do so every three months. Therefore, it is very important that patients attend clinics on a regular basis so that data is current and accurately reflects the patient’s condition. Waiting time accrued on the current list will be carried over into the new scheme.
If any patients on the waiting list have any further questions, they should contact their Recipient Transplant Co-Ordinator.
Notes:
- UKELD a scoring system used to predict prognosis for patients with a liver disease, it takes into account INR, (international normalised ratio), Serum Creatinine, Serum Bilirubin and Serum Sodium.
- Donor characteristics include age, cause of death, BMI, diabetes, donor type, blood group and split liver criteria
- Patient characteristics include age, gender, Hepatitis C, disease group, creatinine, bilirubin, INR, Sodium, Potassium, Albumin, renal support, inpatient status, previous abdominal surgery, encephalopathy, ascites, time on waiting list, diabetes, maximum AFP level, maximum tumour size, two tumours, three or more tumours those patients with variant syndrome disease - this group of patients will now have a better prospect of receiving a transplant match.