For liver transplant programs & NLRB
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 the National Liver Review Board (NLRB).
Adult MELD exception review
This document summarizes available evidence to assist clinical reviewers in approving candidates for adult MELD exceptions.
View adult MELD exception review guidance (PDF - 213 KB)(PDF; 7/1/2025)
Pediatric MELD/PELD exception review
This document summarizes available evidence to assist clinical reviewers in approving pediatric candidates for status 1B exceptions and MELD or PELD exceptions.
View pediatric MELD/PELD exception review guidance (PDF - 310 KB)(updated 7/13/2023)
Adult MELD exceptions for transplant oncology
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) (PDF; 7/1/2025)