title: Standardizing MELD Exceptions: Current Challenges and Future Directions.
abstract: Since MELD-based allocation was implemented in 2002, a system of exception points has been in place in order to award increased waitlist priority to those patients whose severity of illness or risk of complications are not captured by the MELD score. These exceptions, categorized as standardized and non-standardized, have been used with increasing frequency over time. Several challenges to the exception point system have emerged, including lack of standardization in the criteria used to approve such exceptions, geographic variability in the use and approval of such exceptions, and limited evidence base to support certain exceptions. Herein, we summarize the current implementation of exception points, the challenges facing the transplant community, and suggestions for improving and standardizing the current exception point system.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania ; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania ; Leonard Davis Institute of Health Economics, University of Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldberg
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Olthoff
keywords: MELD exceptions; regional review boards; standardized exceptions