# The UK National Appeals Panel Safely Extends Access to Liver Transplantation for Candidates Beyond Standard Listing Criteria

## TL;DR

The UK's National Appeals Panel helps extend liver transplant access to patients who don't meet standard criteria, ensuring fair and safe allocation.

## Contribution

The study demonstrates how a structured appeals process can safely expand liver transplantation access beyond standard listing criteria.

## Key findings

- 85.9% of appeals to the UK National Appeals Panel were approved between 2011 and 2020.
- Transplanted adults had excellent outcomes with 98% one-year and 90% five-year survival rates.
- All 10 pediatric appeals were approved, with nine successfully transplanted.

## Abstract

Liver transplantation (LT) is the definitive treatment for selected acute and chronic liver diseases, yet standard national listing criteria do not encompass all clinical situations. To address this, the United Kingdom (UK) established the National Appeals Panel (NAP) in 2011 to review exceptional cases, aiming to ensure equitable access while safeguarding allocation of scarce donor organs. We conducted a retrospective analysis of all appeals submitted to the NAP between 2011 and 2020. 149 appeals were received: 139 (93.3%) adults and 10 (6.7%) paediatric patients. Overall, 128 (85.9%) appeals were approved, 19 (12.8%) declined, and 2 (1.3%) withdrawn. Approval was more frequent for adult super-urgent than elective requests (92.9% vs. 79.5%). Of 118 approved adults, 95 (80.5%) underwent LT, while 23 (19.5%) did not, most often due to deterioration on the waiting list. Transplanted adults included 46.3% super-urgent cases, with 20% ventilated and 25.3% on renal replacement therapy, yet achieved excellent outcomes with 98% one-year and 90% five-year survival. All 10 paediatric appeals were approved, with one child dying on the list and nine transplanted. Declined appeals mainly involved older patients with malignant indications. This review highlights the NAP’s role in expanding LT access while ensuring equity and governance.

Flowchart titled “The UK National Appeals Panel Safely Extends Access to Liver Transplantation for Candidates Beyond Standard Listing Criteria”. It shows the panel's structure involving the Liver Advisory Group Chair/Deputy and representatives from seven centers. From 2011-2020, 149 appeals occurred: 139 adults (118 approved, 95 transplanted) and 10 pediatric cases (9 transplanted, 6 alive at four years). Declined appeals were 13.7 percent, mainly older patients with malignancies. Adult survival rates: 1-year at 98 percent, 5-year at 90 percent. Transplant International logo included.