The OPTN Policies address operational requirements for OPTN members in areas such as organ allocation, data collection and data reporting. They are separate from the OPTN Management and Membership policies, which cover administrative aspects of OPTN policy development and requirements for OPTN membership.
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OPTN Policy
OPTN policies are rules that govern operation of all member transplant hospitals, organ procurement organizations (OPOs) and histocompatibility labs in the U.S.
Updated 11/13/2025
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Evaluation plan
The OPTN evaluation plan (PDF) provides guidance to member transplant centers, OPOs and histocompatibility labs on how to comply with OPTN policies and bylaws.
Updated 10/1/2025
Recent updates
The OPTN policies were last updated on 11/13/2025 with the implementation of changes related to the 2025 Histocompatibility HLA Table Update proposal.
| Update | Affected policies | Effective date |
|---|---|---|
| 2025 Histocompatibility HLA Table Update (PDF - 691 KB) | 4.11: Reference Tables of HLA Antigen Values and Split Equivalences | 11/13/2025 |
| Improve Deceased Donor Evaluation for Endemic Diseases (PDF - 212 KB) | 2.9: Required Deceased Donor Infectious Disease Testing | 10/1/2025 |
| Align OPTN KPD Blood Type Matching Policy and Establish Donor Re-Evaluation Requirements (PDF - 614 KB) | 13.4.C: Additional Requirements for KPD Donors 13.6.B: Requirements for Match Run Eligibility for OPTN KPD Donors 13.7: Re-Evaluation Requirements for OPTN KPD Donors 13.8.B: Blood Type A, Non-A1, and Blood Type AB, nonA1B Matching | 09/24/2025 |
| Amend Adult Heart Status 2 Mechanical Device Requirements (PDF - 585 KB) | 6.1.B.iv: Percutaneous Endovascular Mechanical Circulatory Support Device 6.1.B.v: Intra-Aortic Balloon Pump (IABP) | 09/10/2025 |
| Monitor Ongoing eGFR Modification Policy Requirements (PDF - 616 KB) | 3.7.D: Waiting Time Modifications for Kidney Candidates Affected by Race Inclusive eGFR Calculations | 09/10/2025 |
| Clarify Requirements for Reporting a Potential Disease Transmission (PDF - 569 KB) | 15.5: Transplant Program Requirements for Communicating Post Transplant Discovery of Disease or Malignancy 15.5.A: Transplant Program Requirements for Post Transplant Discovery of Donor Disease or Malignancy 15.5.B: Transplant Program Requirements for Reporting Post Transplant Discovery of Recipient Disease or Malignancy | 08/01/2025 |
| Revisions to Human Immunodeficiency Virus (HIV) Policies to Align with Federal Regulatory Updates (PDF - 839 KB) | 1.2: Definitions 2.7: HIV Screening of Potential Deceased Donors 2.7.A: Exceptions to HIV Screening Requirement 5.3.B: Infectious Disease Screening Criteria 5.3.D: Liver Acceptance Criteria 5.3.H: Kidney Offer Filters 5.4.E: Allocation to Candidates Not on the Match Run 5.5.C: OPO Requirements for Positive HIV Results 5.8.A: Pre-Transplant Verification Prior to Organ Receipt 5.8.B: Pre-Transplant Verification Upon Organ Receipt 14.3: Informed Consent Requirements 14.4.E: Living Donor Exclusion Criteria 15.2: Candidate Pre-Transplant Infectious Disease Reporting and Testing Requirements 15.3.B: Donors with Risk Identified Pre-Transplant 15.7: Open Variance for the Recovery and Transplantation of Organs from HIV Positive Donors 15.7.A: Requirements for Allocating HIV Positive Deceased Donor Organs 15.7.B: Requirements for Allocating HIV Positive Living Donor Organs 15.7.C: Transplant Hospital Requirements for Transplantation of HIV Positive Organs 16.6.A: Extra Vessels Use and Sharing | 06/26/2025 |
| Require Reporting of HLA Critical Discrepancies and Crossmatching Events to the OPTN (PDF - 248 KB) | 4.4: Critical HLA Discrepancies in Candidate, Donor, and Recipient HLA Typing Results 4.4.B: Requirements to Resolve Critical Discrepant Donor and Recipient HLA Typing Result 4.11.B: HLA Unacceptable Antigen Equivalences 18.5.D: Required Reporting by Histocompatibility Laboratories | 03/05/2025 |
| National Liver Review Board (NLRB) Updates Related to Transplant Oncology (PDF - 733 KB) | 9.5.A: Requirements for Cholangiocarcinoma (CCA) MELD or PELD Score Exceptions | 02/27/2025 |
| Modify Data Collection on Living VCA Donors (PDF - 764 KB) | 14.5.C: Living Donor Blood Type Determination and Reporting 18.1.B: Timely Submission of Certain Data 18.2: Timely Collection of Data | 12/11/2024 |
| Update Human Leukocyte Antigen (HLA) Equivalency Tables, 2023 (PDF - 678 KB) | 4.11.A: HLA Matching Equivalences 4.11.B: HLA Unacceptable Antigen Equivalences 4.11.C: HLA DPB1 Available Alleles | 12/5/2024 |
| Optimizing Usage of Offer Filters (PDF - 540 KB) | 1.2: Definitions 5.3.H: Kidney Offer Filters | 11/14/2024 |
| Refit Kidney Donor Profile Index without Race and Hepatitis C Virus (PDF - 545 KB) | 8.4.B: Deceased Donor Classifications | 10/31/2024 |
| Standardize Six-Minute Walk for Lung Allocation (PDF - 895 KB) | 10.1.A.1 Waitlist Survival Points for Candidates at least 12 Years Old 10.1.B.1 Post-Transplant Outcomes Points for Candidates at least 12 Years Old 10.3 Clinical Values and Update Schedule 10.3.B Lung Clinical Values That Must Be Updated Every Six Months 21.2.A Values Used in the Calculation of Lung Waiting List 21.2.B.1 Coefficients Used in Calculating Lung Post-Transplant Outcomes | 09/03/2024 |
| Clarify Requirements for Pronouncement of Death (PDF - 206 KB) | 2.14.A: Conflicts of Interest 2.15.G Pronouncement of Death | 07/25/2024 |
| Modify Effect of Acceptance (PDF - 534 KB) | 5.6.D Effect of Acceptance | 07/25/2024 |
| Modify Organ Offer Acceptance Limit (PDF - 513 KB) | 5.6.C: Organ Offer Acceptance Limit | 05/29/2024 |
| Remove CPRA 99-100% Form for Highly Sensitized Candidates (PDF - 541 KB) | 5.1.A: Kidney Minimum Acceptance Criteria 8.4.F: Highly Sensitized Candidates | 05/02/2024 |
| Expedited Placement Variance (PDF - 546 KB) | 1.3.B: Creation of a Variance 1.3.C: Joining an Open Variance 1.3.D: Reporting Requirements for Variances 5.4.G: Open Variance for Expedited Placement | 04/02/2024 |
| Establish Member System Access, Security Framework, and Incident Management and Reporting Requirements (PDF - 675 KB) | 3.1: Access to the OPTN Computer Systems | 03/19/2024 |
| Require Reporting of Patient Safety Events (PDF - 566 KB) | 16.2: Packaging and Labelling Responsibilities 18.5: Reporting of Living Donor Events | 01/10/2024 |
| Update Data Collection for Lung Mortality Models (PDF - 334 KB) | 10.1.F: Lung Disease Diagnosis Groups 21.2.A: Values Used in the Calculation of Lung Waiting List Survival 21.2.B.1: Coefficients Used in Calculating Lung Post-Transplant Outcomes | 12/13/2023 |
| Establish Membership Requirements for Uterus Transplant Programs (PDF - 667 KB) | 1.2: Definitions 2.2: OPO Responsibilities 5.4.B: Order of Allocation 5.6.A: Receiving and Reviewing Organ Offers 18.1: Data Submission Requirements 18.2: Timely Collection of Data 18.3: Recording and Reporting the Outcomes of Organ Offers | 12/5/2023 |
| Modify Heart Policy for Intended Incompatible Blood Type (ABOi) Offers to Pediatric Candidates (PDF - 565 KB) | 6.6.B.i: Eligibility for Intended Incompatible Blood Type Heart Offers 6.6.B.ii: Blood Type Matching Priority for Intended Incompatible Blood Type Hearts 6.6.B.iii: Reporting Requirements for Recipients of Intended Incompatible Blood Type Hearts 10.4.A: Eligibility for Intended Blood Group Incompatible Offers for Deceased Donor Lungs | 11/30/2023 |
| Establish Member System Access, Security Framework, and Incident Management and Reporting Requirement (PDF - 675 KB) | 3.1.A: Security Requirements for Systems Accessing the OPTN Computer System | 11/20/2023 |
| Update Multi-Organ Allocation for Continuous Distribution of Lungs (PDF - 260 KB) | 5.10.F: Allocation of Lung-Kidneys 5.10.G: Allocation of Heart-Liver and Lung-Liver | 09/28/2023 |
| Establish Eligibility Criteria and Safety Net for Heart-Kidney and Lung-Kidney Allocation (PDF - 689 KB) | 5.10.E: Other Multi-Organ Combinations 5.10.F: Allocation of Lung-Kidneys 5.10.G: Allocation of Heart-Liver and Lung-Liver 8.6.C: Kidney Allocation in Multi-Organ Combinations | 09/28/2023 |
| Expand Required Simultaneous Liver-Kidney Allocation (PDF - 227 KB) | 9.9: Liver-Kidney Allocation | 09/28/2023 |
| Modify Lung Allocation by Blood Type (PDF - 566 KB) | 10.1.C.1: Blood Type | 09/27/2023 |
| Programming VCA Allocation in UNet (PDF - 779 KB) | 2.2: OPO Responsibilities 3.6.A: Waiting Time for Inactive Candidates 5.3.B: Infectious Disease Screening Criteria 5.4.B: Order of Allocation 5.6.A: Receiving and Reviewing Organ Offers 5.6.B: Time Limit for Review and Acceptance of Organ 12.2: VCA Allocation 18.1.B: Timely Submission of Certain Data 18.3: Recording and Reporting the Outcomes of Organ | 09/14/2023 |
| Modify Graft Failure Definition for VCA (PDF - 594 KB) | 1.2: Definitions 12.1: Waiting Time 18.1: Data Submission Requirements | 09/14/2023 |
| Align OPTN Policy to Support Changes to Race and Ethnicity Data Collection (PDF - 579 KB) | 2.11: Required Deceased Donor Information 5.4.A: Nondiscrimination in Organ Allocation 8.4.B: Deceased Donor Classifications 13.6.A: Requirements for Match Run Eligibility for Candidates 13.6.B: Requirements for Match Run Eligibility for Potential KPD Donors | 9/14/2023 |
| Ongoing Review of National Liver Review Board (NLRB) Diagnoses (PDF - 673 KB) | 9.5.I.i: Initial Assessment and Requirements for HCC Exception 9.5.I.ii: Eligible Candidates Definition of T2 Lesions 9.5.I.iii: Lesions Eligible for Downstaging Protocols 9.5.I.iv: Candidates with Alpha-fetoprotein (AFP) Levels Greater than 1000 Policy 9.5.I.v: Requirements for Dynamic Contrast-enhanced CT or MRI 9.5.I.vi: Imaging Requirements for Class 5 Lesions 9.5.I.vii: Extensions of HCC Exceptions | 07/13/2023 |
| Improving Liver Allocation: MELD, PELD, Status 1A and Status 1B (PDF - 667 KB) | 1.2: Definitions 9.1.B: Pediatric Status 1A Requirements 9.1.C: Pediatric Status 1B Requirements 9.1.D: MELD Score 9.1.E: PELD Score 9.1.F: Liver-Intestine Candidates 9.2: Status and Laboratory Values Update Schedule 9.7.C: Points Assigned by Diagnosis (New) 9.8.D: Sorting within Each Classification | 07/13/2023 |
| Change Calculated Panel Reactive Antibody (CPRA) Calculation | 1.2: Definitions 4.6: Calculated Panel Reactive Antibody (CPRA) Calculation 4.9: HLA Antigen Values and Split Equivalences 4.10.B: HLA Unacceptable Antigen Equivalences 5.3.A: Reporting Unacceptable Antigens for Calculated Panel Reactive Antibody (CPRA) 8.1: Calculated Panel Reactive Antibody (CPRA) 11.1: Calculated Panel Reactive Antibody (CPRA) | 1/26/2023 |
| Establish OPTN Requirement for Race-Neutral eGFR Calculations | 1.2: Definitions 3.6.B.i: Non-function of a Transplanted Kidney 8.4.A: Waiting Time for Candidates Registered at Age 18 Years or Older 8.5.G: Prioritization for Liver Recipients on the Kidney Waiting List 9.5.H: Requirements for Primary Hyperoxaluria MELD or PELD Score Exceptions 9.9.B: Liver-Kidney Candidate Eligibility for Candidates 18 Years or Older 13.7.G: OPTN KPD Waiting Time Renistatement | 7/27/2022 |
| Modify Heart Policy to Address Patient Safety Following Device Recall (PDF - 557 KB) | Policy 6.4: Adult and Pediatric Status Exceptions | 7/14/2022 |
| Reinstatement of Updates to Candidate Data During the COVID-19 Emergency | 1.4.F: Updates to Candidate Data During COVID-19 Emergency | 01/11/2022 Expired: 04/11/2022 |
| Administrative changes | 1.1: Rules of Construction | 12/06/2021 |
Explore other policy sections
The OPTN policy development process uses community input to create evidence based rules about organ transplantation.
View notices of implemented policies & bylaws
Summary of implemented policy and bylaws changes approved by the OPTN Board of Directors.
View notices of approved policies & bylaws
Summary of approved policy and bylaws changes.
Information about how UNOS assesses compliance with OPTN policies and bylaws.