Review board members quickly review specific, urgent-status patient registrations on the OPTN heart, liver and lung transplant waiting lists. Review board members collectively determine whether these listings are appropriate, based entirely on clinical information that complies with OPTN policies. Separate boards review exceptions for each organ.
For complete review board member lists, please contact UNOS Customer Service at 800-978-4334.
These guidelines instruct review board members and UNOS staff about the confidential medical peer review process. The guidelines specify requirements for review board members, initial review and appeal process steps, process time frames and possible outcomes.
These resources are not OPTN Policy, so they do not carry the monitoring or enforcement implications of policy. They are not official guidelines for clinical practice, nor are they intended to be clinically prescriptive or to define a standard of care. These resources are intended to provide guidance to transplant programs and review boards.
Review board guidance for HCM/RCM exception requests (PDF - 775 KB) (10/2018)
Effective 10/18/2018
Review board guidance for adult CHD exception requests (PDF - 192 KB) (12/2017)
Review board guidance for adult heart exception requests (PDF - 448 KB) (2/2021)
Review board guidance for pediatric heart exception requests (PDF - 188 KB) (6/2025)
If a transplant hospital submits an adult status exception request that request will be evaluated by review board members in the following regions:
| Transplant hospital region | Assigned review board region (Oct. 2025 - Sept. 2026) |
|---|---|
| 1 | 6 |
| 2 | 3 |
| 3 | 11 |
| 4 | 5 |
| 5 | 2 |
| 6 | 9 |
| 7 | 8 |
| 8 | 10 |
| 9 | 7 |
| 10 | 1 |
| 11 | 4 |
These guidelines instruct review board members and UNOS staff about the confidential medical peer review process. The guidelines specify requirements for review board members, initial review and appeal process steps, process time frames and possible outcomes.
National liver review board guidelines (PDF - 130 KB) (7/2025)
These resources are not OPTN Policy, so they do not carry the monitoring or enforcement implications of policy. They are not official guidelines for clinical practice, nor are they intended to be clinically prescriptive or to define a standard of care. These resources are intended to provide guidance to transplant programs and review boards.
This document summarizes available evidence to assist clinical reviewers in approving candidates for adult MELD exceptions.
Adult MELD exception review guidance (PDF - 213 KB) (7/2025)
This document summarizes available evidence to assist clinical reviewers in approving pediatric candidates for status 1B exceptions and MELD or PELD exceptions.
Pediatric MELD/PELD exception review guidance (PDF - 310 KB) (7/2023)
This document summarizes available evidence to assist clinical reviewers in approving candidates for adult MELD exceptions related to liver cancer and tumors
Adult Meld Exceptions for Transplant Oncology Review Guidance (PDF - 223 KB) (7/2025)
These guidelines instruct review board members and UNOS staff about the confidential medical peer review process. The guidelines specify requirements for review board members, initial review and appeal process steps, process time frames and possible outcomes.