Interprovincial Urgent Liver Program

Interprovincial Urgent Liver Program 

Program purpose

To formalize and operationalize a new age of interprovincial liver sharing in Canada, by applying the new national standards for all viable deceased donor liver allocations occurring in Canada, as set for by the Interprovincial liver sharing policies.

Timeline

What is the IPUL program?

By developing the CTR 20.000 series of interprovincial liver sharing policies, the liver transplant community can leverage the technologies provided by the Canadian Transplant Registry to list new urgent paediatric medical statuses, (along with fulminant liver failure status recipients), match them with potential donors, rank them according to policy, make offers, and record transplant outcomes. The technology will provide a streamlined offering process while also allowing for a new level of transparency, accountability, and trust in Canadian interprovincial liver allocations.

What recipients are eligible to participate in the IPUL program?

• 4F In intensive care requiring mechanical ventilation for fulminant liver failure, including primary nonfunction of a graft; without liver transplantation, death is considered imminent.

• 3F In intensive or equivalent care facility for fulminant liver failure but not on mechanical support, who fulfills the King’s College criteria for high risk of mortality without liver transplantation.

• 3LS (NEW) Paediatric patients requiring a combined liver / small bowel

• 3P (NEW) Paediatric patients weighing less than or equal to 6kg.

Program objectives and goals

• To standardize and expand upon the current listing criteria for waiting medically urgent liver recipients by adding two new paediatric recipient medical statuses (3LS and 3P) along side the existing class of medically urgent status liver recipients (4F and 3F).

• To solve for interprovincial disagreements by ensuring that paediatric medical status 3F and 3LS (paediatric liver-small bowl) recipients are listed according to the newly defined eligibility criteria.

• To standardize the use of Meld-Na and PELD calculations provided by IPUL policy to be performed for all IPUL eligible recipients.

• To provide a national level of transparency and accountability in the matching, ranking and allocation of deceased donor livers for Canadians.

• To collect necessary data sets to effectively monitor and report upon program allocations, offers and transplantation activities.

• To collect IPUL recipient transplant outcomes to ensure effectiveness of the program’s matching, and patient safety.

Key Features

Donor and recipient organ donation organizations (ODOs)

• IPUL recipient allocation results – the CTR returns a ranked list of urgent status recipients specifically matching your donor’s ABO, demographics, and serological profile.

• Propose, track, accept and decline offers.

• Organ recovery disposition.

• Shipping status disposition.

• Notification from CTR to all ODOs of newly listed urgent status liver recipients.

• Notification from CTR to all ODOs of no longer urgent offlisted liver recipients.

• Notifications from CTR, and verbally by phone, to the included ODOs in when IPUL offers are proposed, accepted, declined, cancelled acceptance, or withdrawn.

• Notification of an available liver also be made to all other tied and lower ranked recipient ODOs with a matched pediatric 3F or 3LS (with a Meld-Na score of > 35) recipient, allowing for organ deferral discussion.

Recipient organ donation organizations and transplant centres

• Expansion of urgent status listings to include medical statuses 4F (adult and pediatric), 3F (adult and paediatric), 3LS (paediatric only), and 3P (paediatric only).

• MELD-Na, PELD and CPALS score capture.

• Prioritization of 3LS patients whose score is >35 alongside 3Fs.

• Notification alerts of offer acceptance, decline, cancelled acceptance, or withdrawal.

• Peri- & Post-Transplant data captures.

Expected Benefits

Donor organ donation organizations:

• Easy Recipient Identification: Offering coordinators are provided with an allocation list of matched and ranked recipients for the individual deceased donor through which offers should progress in order.

• Removing the guess work: Peace of mind knowing ODOs are offering to realistic potential transplant recipients. The IPUL allocation will only return recipient matches based on ABO compatibility (including accepting of ABOi) and filters out recipients with other incompatible demographic and serological contraindications to accepting.

• Streamlined workflow: As the number of daily active IPUL urgent recipients is predicted to be in the single digits, if no IPUL matches are returned by CTR offering coordinators can focus on allocating the liver locally.

• 4F & 3F listing confidence and clarity: Although physician-to-physician conversations may be called for, CTR’s capturing of 3F listing eligibility criteria ensures that important data is available to an offering ODO upfront for review.

Recipient organ donation organizations, transplant centres, and recipients

• List more patients: IPUL creates new space for a greater number of urgent need recipients’ access to the national donor pool available in interprovincial liver sharing.

• Better quality offers: When the donor acceptance criteria filters (accept ABOi, Weight, Age, etc.) are set for the liver recipient, acting like a sieve, the CTR will consider them and will let through only donors with the desired qualities and eliminating donors with known undesirable qualities.

• Putting urgent status Recipients at “Top of the List”: Recognizing that a deceased liver donor undergoes initial recipient matching through an IPUL allocation process, recipients with urgent statuses are identified, prioritized, and ranked to ensure they are at the forefront of the list to receive an offer.