Interprovincial Organ Sharing Liver Program

Purpose

To establish a deceased donor liver interprovincial Organ Sharing Program (aka IPOS Liver) that standardizes interprovincial sharing processes and improves transparency in eligibility criteria for IPOS Liver allocation criteria and transplant outcomes.

 

Rationale

Background

In 2006, Canada's liver transplant community discussed urgent status liver recipients, identifying the need for a national approach to interprovincial organ sharing. In 2010, the Canadian Liver Transplant Network (CLTN) engaged with Canadian Blood Services as a national collaborator and subject matter expert to support ongoing work toward more consistent national coordination.  

Canadian Blood Services subsequently implemented the National Organ Waitlist (NOW) and supported the national “handshake agreement” through NOW processes and urgent status alerts, providing an initial foundation for standardized notification and coordination. Building on broader national progress in interprovincial organ sharing, Canadian Blood Services led a foundational Liver Listing and Allocation Forum in 2016, in collaboration with CLTN and the Canadian Society of Transplantation (CST).  The forum focused on building a national consensus on key program design elements, including eligibility requirements for urgent listing, the frameworks for candidate matching, and ranking prioritization rules. Policies were drafted to support these discussions. 

In 2017, policy development progressed into provincial approvals and signoffs, including both administrative and clinical endorsement from each province. Following a pause associated with the COVID-19 pandemic, engagement with the liver community resumed in 2024, with liver working groups and a project steering committee reestablished to refine the original policies based on working group feedback and implementation planning needs.  

 

What is the scope of the project?

In scope:

The IPOS Liver project will support the interprovincial sharing of deceased donor livers for defined urgent and highly specialized liver transplant candidates. The project includes the clinical criteria, business processes, Canadian Transplant Registry (CTR) application and Application Programming Interface (API) functionality enhancements, standardized offering workflow, and outcome monitoring activities required to support national liver sharing.

The IPOS Liver project includes the interprovincial sharing of deceased donor livers for the following liver transplant candidates: 

  • Medical Status 4F transplant candidates 
  • Medical Status 3F transplant candidates 
  • Paediatric transplant candidates requiring a multivisceral transplant, such as liver, small bowel, stomach, colon, and pancreas (3LS) 
  • Paediatric transplant candidates less than or equal to 6 kg (3P) 

The implementation will include the use of the CTR application and API to support the listing of liver transplant candidates and the recording of donor acceptance criteria. For candidates requiring a liver/small bowel transplant, the Model for End-stage Liver Disease (MELD)/ Paediatric End-stage Liver Disease (PELD) score will be recorded in CTR. 

The CTR will also be used to support national tracking of liver imports, exports, and program outcomes to enable ongoing monitoring, reporting, and program evaluation. 

Out of scope:

The following areas are out of scope for IPOS Liver project implementation: 

  • Living liver donation 
  • Deceased donor split liver allocation 
  • Allocation of Lung-Liver and Heart-Liver organ clusters 
  • Urgent notifications for paediatric transplant liver-small bowel/multi-visceral, and “3P” candidates weighing > 6 kg 
  • Adult transplant candidates requiring a multivisceral transplant, such as liver, small bowel, stomach, colon, and pancreas 
  • Transplant candidates with non-urgent status listings 
  • Import and export thresholds

 

Who is impacted by the change and what does it mean to them?

The IPOS Liver project implementation will impact clinical, operational, technical, and administrative stakeholders involved in interprovincial liver sharing. The nature of the change will vary by role depending on each stakeholder’s involvement in candidate listing, donor offer review, allocation, transplant coordination, system, sharing and monitoring of post transplant outcome data.

Stakeholders Impacted by the Change

Liver Surgeons

Liver surgeons will be impacted through the standardized interprovincial liver offering and acceptance process. They may need to review allocation information, assess donor offers in accordance with national sharing criteria, support timely acceptance decisions, and align clinical decision-making with the standardized IPOS Liver workflow. 

Hepatologists

Hepatologists will be impacted through candidate identification, clinical eligibility assessment, and documentation requirements. They may support confirmation of candidate status, MELD/PELD information where applicable, and clinical information needed for listing and offer review. 

Pre-Transplant Coordinators

Pre-transplant coordinators will experience workflow changes related to listing eligible liver transplant candidates, recording or validating donor acceptance criteria, ensuring required candidate information is complete in the CTR, supporting offer review activities, and coordinating communications between clinical teams and ODOs. 

Post-Transplant Coordinators

Post-transplant coordinators will be impacted by transplant outcome documentation and follow-up reporting requirements. They may support the recording of transplant outcomes, completion of outcome monitoring surveys, and collection of information needed for program evaluation. 

Liver Transplant Program Managers

Program managers will be responsible for supporting local readiness, workflow adoption, staff awareness, training participation, policy and procedure alignment, and resource planning. They may also support issue escalation, implementation monitoring, and coordination across clinical and administrative teams. 

ODO Coordinators

ODO coordinators will be impacted by standardized processes for interprovincial liver offers, including communication with transplant programs, coordination of donor information, offer sequencing, documentation of offer outcomes, and import/export tracking. 

ODO Digital Departments

ODO digital teams will be impacted by technical and data exchange requirements related to CTR application and API use. This may include supporting local system readiness, API integration, data mapping, testing, troubleshooting, and coordination with CTR technical teams

 

What is Changing and How Does it Work?

The IPOS Liver program will introduce a standardized national process for the interprovincial sharing of deceased donor livers for defined urgent and specific paediatric high priority liver transplant candidates and clarify how deceased donor livers are shared between provinces. The change will support fair and timely national access for medical status 4F and 3F (Fulminant status), paediatric candidates requiring liver & small bowels and/or other multivisceral transplant (3LS), and paediatric candidates weighing less than or equal to 6 kg (3P). 

IPOS Liver will improve national access for paediatric liver transplant candidates requiring liver/small bowel transplant and paediatric liver transplant candidates less than or equal to 6 kg. The addition of the 3LS status will ensure that paediatric liver/small bowel and/or other multivisceral transplant candidates have access to a national donor pool while reserving the use of the 3F medical status for fulminant status candidates only. 

Eligible liver transplant candidates will be listed in the CTR, including required clinical information and donor acceptance criteria. Where applicable, MELD/PELD scores will be recorded in the CTR for candidates requiring liver and small bowel transplant. The CTR will simplify the interprovincial allocation process by producing a ranked allocation list of matching candidates, making and managing offers, and recording decline reasons. The CTR will also be used to track imports, exports, transplant outcomes, and program outcomes. Outcome information will support national monitoring, reporting, program evaluation, and future improvements to the IPOS Liver program. 

 

What are the expected implementation timelines?

IPOS Liver Implementation Timeline

In 2026, the IPOS Liver project implementation advances toward a full operational and technical implementation approach. The implementation will include the required process, policy, workflow, training, monitoring, and technical components needed to support national liver sharing through the IPOS Liver program. 

The full technical implementation includes the CTR-enabled matching allocation functionality to generate a ranked allocation lists for deceased donor livers, with timeline of implementation still to be determined. Implementation timeline to come following policy approval by the steering committee and provincial partners, which is expected by the end of 2026.

 

How to get in touch

For questions about the project, please email the IPOS Liver team at ipos.programs@blood.ca

 

About Canadian Blood Services

Canadian Blood Services works with the Organ and Tissue Donation & Transplantation (OTDT) community to improve national system performance. We do this through coordination of interprovincial organ sharing policies and programs through the Canadian Transplant Registry, the development of leading practices, professional education, public awareness and data analysis and reporting. 

About the Canadian Transplant Registry (CTR)

Interprovincial Urgent Liver Program Project Implementation