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Organ transplants in United States set sixth consecutive record in 2018

The 36,527 organ transplants performed in the United States in 2018 set an annual record for the sixth straight year, according to preliminary data from United Network for Organ Sharing (UNOS), which serves as the national Organ Procurement and Transplantation Network (OPTN) under federal contract. In 2018, the total number of organ transplants exceeded 750,000 performed since 1988, the first full year national transplant data were collected.

The number of transplants, using organs from both deceased and living donors, increased five percent over 2017. Approximately 81 percent (29,680) of the transplants performed in 2018 involved organs from deceased donors. Living donor transplants accounted for the remaining 19 percent (6,849). The number of living donor transplants represented the highest total since 2005 and increased nearly 11 percent over 2017.

“We are incredibly proud and grateful to have facilitated a record number of lifesaving organ transplants in 2018,” said Sue Dunn, president of the OPTN/UNOS Board of Directors. “We never forget that our work is made possible by the selfless donors and their courageous families who make the powerful decision to give the gift of life. We will continue to work tirelessly to maximize that gift on behalf of the nearly 114,000 who await a transplant.”

In 2018, 10,721 people provided one or more organs for transplantation as deceased organ donors. This was a four percent increase over the 2017 total, and it continues an eight-year trend of record-setting donation.

While the number of potential deceased organ donors varies among different areas of the country due to differences in population size and medical characteristics, increases were noted in many areas. Of the 58 organ procurement organizations (OPOs) coordinating deceased organ donation nationwide, 41 (70 percent) experienced an increase in donors from 2017 to 2018, including at least one OPO in each of UNOS’ 11 regions.

“A key to continuing the success of the field is to support efficient decision-making and improve communications among OPOs and transplant centers,” said Brian Shepard, Chief Executive Officer of UNOS. “We are working on a number of innovation projects to increase the efficiency of these key processes.”

As in several previous years, some of the increase in deceased donation is due to increased usage of donors with a broader set of medical criteria than was considered in the past. Nearly 20 percent of donors in 2018 donated after circulatory death as opposed to brain death. Nine percent of deceased donor kidney transplants involved organs with a kidney donor profile index (KDPI) score of 86 or higher, which may function less time compared to low KDPI kidney offers but may also shorten the waiting time for transplant candidates. Other donor characteristics setting all-time records in 2018 included an age of 50 or older and/or being identified as having increased risk for blood-borne disease.

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OPTN/UNOS operations not affected by partial federal shutdown

UNOS, which serves as the Organ Procurement and Transplantation Network (OPTN) under federal contract, continues to provide all services without interruption despite the shutdown of some federal government functions that began December 22, 2018. All UNetSM applications and the donor matching system remain operational, and all UNOS staff will continue to maintain their regular schedules.

Should there be any need for an update in the longer term, we will inform you at that time.

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100 people transplanted thanks to HOPE Act

Thanks to the HIV Organ Policy Equity Act (the HOPE Act), 100 organ transplants have been performed for HIV-positive candidates willing to accept organ offers from HIV-positive donors. As of December 18, 15 hospitals participating in HOPE Act protocols performed those 100 transplants. These include 69 kidney transplants and 31 liver transplants, involving organs from 49 deceased donors.

“The collective effort by the transplant community is bringing more opportunity to these patients. As a result, it also expands access for everyone waiting for an organ transplant,” said UNOS Chief Medical Officer David Klassen.

Most of the transplants allocated through the HOPE Act have occurred in 2018, as more and more organ procurement organizations have developed recovery protocols. Organs from donors that initially test positive for HIV have been transplanted into HIV-positive recipients since 2016; 19 in 2016, 21 in 2017 and 60 so far in 2018. This indicates that more and more HIV-positive people are becoming aware that they can leave the legacy of life through organ donation.

Supporting HIV-positive candidates

UNOS has been supporting HIV-positive candidates through the HOPE Act since its implementation. “The HOPE act has provided the ability to transplant organs from individuals not previously considered as donors. This has increased the opportunity for HIV+ recipients on the waiting lists to be transplanted,” said Klassen. “The HOPE Act program was slow to get started but in recent months as more transplant centers have initiated HOPE Act transplant programs and OPOs have identified additional donors, the number of transplants has increased substantially.” Signed into law November 2013 and implemented November 2015, the HOPE Act opened the door for HIV-positive candidates to receive and donate organs. The act allows research on transplantation of organs from donors identified as HIV-positive into HIV-positive candidates under approved research protocols. Organ procurement organizations can run matches for HIV-positive donors. The only candidates who appear on match runs for these donor offers are those listed at transplant programs that have an IRB-approved protocol, who are confirmed as HIV-positive, and who are willing to accept an HIV positive kidney or liver. Any participating hospital must conduct transplants under IRB-approved research protocols conforming to the Final Human Immunodeficiency Virus (HIV) Organ Policy Equity (HOPE) Act Safeguards and Research Criteria for Transplantation of Organs Infected with HIV, developed by the National Institute of Allergy and Infectious Diseases, one of the National Institutes of Health.

Educating HIV patients about organ donation

Current estimates suggest that more than 1.2 million people are HIV-positive; 35,000 people are newly infected every year. While life expectancy of HIV positive patients nears that of the general population, end-stage liver or kidney disease is expected to increase as the population ages, creating an even greater need for more organs. It’s critically important to educate HIV patients about the HOPE Act and organ donation if the availability of these organs is to grow. Search for a participating transplant hospital.

Bringing hope to the entire transplant community

Transplanting organs from HIV-positive donors into HIV-positive candidates shortens the waitlist, increasing the organ availability from HIV-negative donors for HIV-negative recipients. In addition, it gives hope and comfort to the family of donors, knowing their loved ones have saved the lives of other HIV-positive patients.

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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.

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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.

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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.

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