Liver distribution proposal advances for board consideration
Chicago – The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee, at its meeting Nov. 2, voted to advance a proposal to revise liver distribution policy for a final vote by the OPTN/UNOS Board of Directors at its Dec. 3-4 meeting. The proposal is intended to establish greater consistency in the geographic areas used to match liver transplant candidates with available organs from most adult deceased donors and reduce geographic differences in liver transplant access.
“We believe this reflects a commitment to transplant the most urgent candidates while balancing a number of key issues affecting the liver transplant process,” said committee chair Julie Heimbach, M.D. “We’re committed to closely monitoring the impact of this policy and to making modifications if further optimizations are identified.”
The proposal would replace fixed, irregular local and regional geographic boundaries historically used to match liver candidates based on the donor location. It would initially prioritize liver offers from most deceased adult donors in the following sequence:
- the most medically urgent candidates (Status 1A and 1B) listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital
- candidates with a MELD or PELD score of 29 or higher listed at transplant hospitals within a radius of 250 nautical miles from the donor hospital
- candidates with a MELD or PELD score between 15 and 28 listed at transplant hospitals within a radius of 150 miles from the donor hospital
Livers from deceased donors older than age 70, and/or those who die as a result of cardiorespiratory failure, will be exempt from this distribution. Most of these organs are accepted for local candidates, since they are most viable when the preservation time between recovery and transplantation is short. In addition, this distribution sequence would not apply to livers from deceased donors younger than age 18, which are preferentially considered for pediatric transplant candidates.
The committee further recommended that the implementation of revised liver distribution policy occur no sooner than three months from the pending implementation of a new National Liver Review Board (NLRB), which is scheduled to occur in early 2019. Also, upon NRLB implementation, the committee recommended that standardized exception scores for liver candidates be capped at 28, so that candidates with these scores would not outgain priority for urgent candidates based on calculated MELD/PELD scores. Transplant hospitals, using their medical judgment, may request exception scores higher than 28 from the NLRB for individual candidates.
Simulation modeling of the proposed changes indicate they would reduce variation in transplants by MELD score that exist in various areas of the country under the current liver distribution system. Modeling further predicts that the changes should reduce pre-transplant deaths and increase access for liver transplant candidates younger than age 18. In addition to modeling results, the committee reviewed opinions, recommendations and questions from more than 1,200 public comments submitted between Oct. 8 and Nov. 1.
UNOS wins contract to continue as national transplant network
Richmond, VA – United Network for Organ Sharing (UNOS) has again won a competitive federal contract to serve as the nation’s Organ Procurement and Transplantation Network (OPTN). UNOS has fulfilled this role since the OPTN began in 1986, under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services (HHS).
“UNOS is committed to continually improving the nation’s transplant system,” said UNOS Chief Executive Officer Brian Shepard. “Donors, their families, and waiting transplant candidates depend on us.”
Last year, the number of organ transplants in the United States reached a new high for the fifth consecutive year, and the number of transplants is expected to exceed 36,000 in 2018.
All transplant hospitals and organ procurement organizations nationwide are members of the OPTN. The OPTN contract requires a number of critical functions, including:
- developing and implementing equitable organ distribution policies
- collecting detailed data on all transplant candidates and recipients, as well as living and deceased organ donors
- conducting research to improve performance of the national transplant system
- assisting in organ placement for transplantation
- monitoring members for patient safety and quality
- reviewing issues involving potential risks to the health and safety of transplant candidates, recipients and/or living donors
Including option years, the new contract will run through September 2023. Total funding over the length of the contract is estimated to be nearly $250 million. The federal government will fund approximately 10 percent of that amount. The remainder of contract funding comes from fees assessed to individual member institutions.
Areas of additional emphasis under the new contract include:
- enhancing professional and public involvement in OPTN policy development, such as developing and hosting professional symposia on key policy-related issues
- continuing to foster innovation in providing projects and services to increase organ utilization and improve the organ matching process
- furthering the development and use of metrics in assessing the effectiveness of OPTN policy implementation and of monitoring members for patient safety and quality
Separate from its OPTN responsibilities and with private funding, UNOS, a non-profit, 501(c)3 charitable membership organization, leads other efforts to support organ donation and transplantation. These activities include:
- collaborating with members on continuous improvement initiatives to strengthen and enhance their work
- conducting innovative research to increase the number of transplants and enhance transplant outcomes
- offering information to guide potential living donors, transplant candidates and their caregivers in their decision-making
UNOS is based in downtown Richmond, Va. UNOS is also the home of the National Donor Memorial to honor the spirit and the legacy of organ and tissue donors.
Special public comment period addresses liver distribution
From October 8 through November 1, the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee seeks public comment on a proposal to replace donor service areas (DSAs) and regions in distribution policies for livers and intestinal organs.
The proposal would allocate livers to candidates within 150, 250, or 500 nautical miles (nm) of donor hospitals before offering them nationally, to allow for efficient placement of donor organs and to avoid organ wastage. Livers would be allocated to Status 1A and 1B candidates within 500nm first. Candidates with a Model for End-Stage Liver Disease (MELD) score of at least 32 would then be offered livers if they were within 250nm of the donor hospital. Then livers would be offered to candidates with a MELD of 15-31, first within 150nm, then within 250nm, then within 500nm. After that, livers would be offered to Status 1A and 1B candidates and candidates with MELD or PELD scores of at least 15 across the nation.
Comments and replies will be published on the OPTN public comment page, to promote transparency and trust in the national transplant system.
We encourage patients, transplant candidates and recipients, living donors, donor families and transplant professionals to learn more about the proposal and provide valuable feedback to help shape U.S. organ transplant policy. The public comment page also includes information about webinars to provide more information about the proposal and opportunities to provide input.
OPTN disaster relief information refresher
We would like to assure transplant patients that we are in contact with the transplant centers and organ procurement organizations that may be affected by Hurricane Florence. Our organ center is ready to help these organizations and ensure that essential services are not interrupted. We encourage you to contact your transplant center directly if you have any questions related to the storm.
Constituent Council initiative tests options to improve committee structure
The Executive Committee is sponsoring a proof of concept project to test options to improve the OPTN/UNOS Committee structure through enhanced communication and engagement.
In spring 2018 public comment, feedback to the concept paper entitled “Improving the OPTN/UNOS committee structure” indicated significant concerns about specific recommendations, but general support for the overarching goals of broadening committee engagement, improving intra-Committee communication, and increasing engagement between the Board and committees. The Executive Committee carefully considered feedback. They discussed forging ahead with a formal proposal based on the concept paper, abandoning the project, or testing a modified version of the proposed structure that addresses concerns raised during public comment. Ultimately, they decided to pursue this latter option.
The proof of concept, which will be tested during the fall public comment cycle, maintains the original structure and purpose of all committees. It also maintains the ability for any committees to sponsor policy projects.
Two committees, Patient Affairs and Transplant Coordinators, are testing a “Constituent Council” structure: a constituency’s official representatives on other committees (e.g. the patient representative on the Kidney Committee) as well as that constituency’s representatives on the Board of Directors will merge with the current roster of members for that committee. This proof of concept also invites other members of the constituency who self-identify as having a patient or clinical transplant coordinator perspective, but do not serve in that official capacity on their home committee (e.g. an OPO representative on the Liver Committee who is also a recipient).
The proof of concept will last from July 1, 2018-December 30, 2018. Lessons learned will be used to determine future expansions of the proof of concept.
Upcoming heart allocation policy change
If you are a patient on the national waiting list for a heart, your urgency for a transplant is currently based on three statuses:
- 1A (most urgent)
- 1B (somewhat urgent)
- 2 (least urgent)
As we learn more about heart disease and successful treatment of it, the transplant community determined we needed more specific criteria that reflects a heart patient’s current health and care they are getting. To accommodate these needs, we are making changes to heart policy and the first phase of the new heart allocation policy will take effect on September 18.
Heart candidates can find specific information here about how this change will affect you. You can also download a print version from the website.