UM Guidelines
Liver Transplant, Pediatric

Inpatient and Surgical Care (ISC)

BCBST last reviewed April 2, 2019*

Added to Clinical Indications:
Model for end-stage liver disease (MELD) score 6 through 40


Updated contraindications:

No active alcohol or illicit substance use. [B] A minimum three month abstinence period documented in medical record is required with a current negative drug and/or alcohol screen.


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BlueCross BlueShield Association. Medical Policy Reference Manual. (9:2017). Liver Transplant and combined liver-kidney transplant (7.03.06). Retrieved May 23, 2018 from BlueWeb.

BlueCross BlueShield of Tennessee network physicians. December 2018.


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