Top-Performer Centers: How the Flag Works
Our top-performer flag marks liver programs offering at least 80% of the ten capabilities we track. Here is the exact rule, and what it can't tell you.
The "Top-performer" filter on the comparison map highlights every center that runs at least 80% of the program capabilities we track. The rule is simple, public, and auditable. No black-box composite score, no proprietary weighting.
The rule
A center is flagged a top performer when the number of tracked capabilities it offers, divided by the number of capabilities that apply to it, is 0.80 or higher.
- Capability count: how many of the tracked capabilities are marked TRUE for that center.
- Clinician corrections: where a clinician has verified that a center offers a capability the public data misses, that verified answer is added.
- Sister hospitals: when two hospitals are run by the same surgical team, a capability offered at one counts for both, because the same team provides it.
- Adult-only centers: an adult center with no pediatric partner is not scored on the pediatric living donor program, since that capability does not apply to it.
What's in the capability set
We track ten program capabilities for every center:
- NMP-capable: normothermic machine perfusion (any device). Keeps the donor liver warm and supplied with oxygen outside the body. See how NMP works.
- HOPE-capable: hypothermic oxygenated perfusion. Cools the liver while pumping oxygenated fluid through it. See HOPE explained.
- DCD program: uses livers from donation after circulatory death. See DCD vs. brain death donors.
- Split-liver program: one donor liver split between two recipients.
- Reduced-size graft program: a graft trimmed to fit a smaller recipient.
- ABO-incompatible program: protocols for transplant across blood types.
- Living donor program: adult-to-adult or pediatric living donation. See our living donor page.
- Dual-listing friendly: actively supports patients listing at a second center. See dual listing.
- ECD program: extended-criteria donor acceptance (older, hepatitis-positive, or fatty livers). See ECD donors.
- Pediatric living donor program: a living donor pathway for pediatric recipients.
A center needs at least 8 of 10 capabilities to be flagged. For an adult-only center scored on 9 capabilities, the bar is at least 8 of 9 (7 of 9 is about 78%, just under the line).
Why these capabilities matter to a patient on the list
Each capability is a different way a program can say "yes" to more donor livers, or to more kinds of patients.
- Machine perfusion can let teams use livers that might otherwise go unused. In a randomized trial of 220 liver transplants, normothermic preservation was linked to 50% less graft injury and a 50% lower rate of discarded organs compared with standard cold storage, with no significant difference in patient or graft survival (Nasralla et al., Nature 2018).
- DCD, ECD, split-liver, and reduced-size programs widen the pool of livers a center is willing to use.
- Living donor programs create a path that does not depend on a deceased donor offer.
- Dual-listing friendly programs make it easier to add a second listing, which national policy allows (SRTR FAQ for patients).
A program that offers many of these has more tools. That is all the flag claims.
Why 80%, why this set
- 80% is a deliberately high bar. Few centers run all ten programs; the 80% threshold surfaces the broadest-capability ones without inflating the list.
- Capability breadth ≠ outcomes for every patient. A program with eight capabilities but a structural weakness in your specific diagnosis may not be your best center. The flag is a starting point for further conversation, not a ranking.
- The data comes from clinician-verified flags and public program information. We never derive a capability from advertising copy. SRTR reports cover some related activity, such as living donor transplants in a year, but they do not report most of these capabilities.
How this differs from SRTR's ratings
The flag is not an outcome score. The Scientific Registry of Transplant Recipients (SRTR) rates outcomes such as "Getting a Transplant Faster," "Survival on the Waitlist," and "1-Year Survival" on a 5-tier scale. Tiers 1 and 2 mean outcomes worse than expected for that program's patients, tier 3 means about the national rate, and tiers 4 and 5 mean better than expected (SRTR, dial icons). SRTR has used this 5-tier approach since 2016 (Wey et al., 2018).
Use both. Our flag tells you what a program can do. SRTR's tiers tell you how its patients have done. SRTR program reports come out each January and July (SRTR, Program-Specific Reports).
What the flag does NOT capture
- Insurance acceptance for your specific plan. Always call. Our article on confirming insurance by phone has a script.
- Your wait time at this center for your MELD score and blood type. Aggregate medians hide this. Compare median MELD at transplant by center.
- Caregiver experience, parking, lodging, social work staffing. Not in the SRTR data.
- Subspecialty fit. A program excellent at liver cancer (HCC) may not be the right fit for a patient with PSC. Or vice versa.
- How often the program actually uses each capability. Offering split-liver or DCD transplants is not the same as doing many of them.
If a center you trust isn't on the top-performer list, that doesn't mean they're a poor program — it may simply mean they've chosen to specialize rather than run every capability. Use the individual capability filters (NMP, HOPE, ECD, etc.) to find a match for your specific clinical needs.
Questions to ask a program
- "Which of these capabilities do you offer today, and how many of those transplants did you do last year?"
- "Would my case be a candidate for machine perfusion, a DCD liver, or an extended-criteria liver?"
- "Do you have a living donor program for someone my size and diagnosis?"
- "Will you support me if I want to list at a second center?"
- "What are your SRTR tiers for getting a transplant faster and for waitlist survival?"
Common misconceptions
- "Top performer means best outcomes." No. It means broadest set of capabilities. Check SRTR outcomes separately.
- "No flag means avoid this center." No. Many strong programs focus on fewer services.
- "The flag is permanent." No. It is recalculated from current data whenever the map loads, so it changes when a program adds or drops a capability.
Where the flag appears
- Gold halo ring on every top-performer pin on the map (always on; you don't have to filter to see it).
- Hero strip in the Navigator showing the closest top-performer to your ZIP, or the national count if you haven't entered a ZIP yet.
- "Top-performer centers" caregiver-flag picklist that culls the map to only top-performers when you want a focused view.
You can also browse every program in our transplant center directory.
Sources
- Nasralla D, et al. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018
- SRTR — Understanding the dial icons and 5-tier ratings
- Wey A, et al. A Five-Tier System for Improving the Categorization of Transplant Program Performance. Health Serv Res. 2018
- SRTR — Program-Specific Reports (PSR)
- SRTR — FAQs for patients and donors
Educational only. Not medical advice. Your transplant team has the final word.
