Stories

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.

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.

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.

Richmond, Va. – The OPTN/UNOS Board of Directors, at its meeting June 11-12, adopted a set of principles to guide future organ transplant policy relating to geographic aspects of organ distribution. The Board approved the principles by a vote of 32 in favor and five opposed.

“Geography presents inherent challenges in developing equitable transplant policy for candidates across the nation,” said Yolanda Becker, M.D., president of the OPTN/UNOS Board of Directors. “There are differences in the distribution of transplant centers and in the size and configuration of organ procurement organizations. In addition, there is geographic variability in the concentration of disease patterns that cause organ failure and causes of death that make organ donation possible. Adopting these principles is a necessary first step to address issues of geography in a systematic way.”

The statement of principles reads as follows:

Deceased donor organs are a national resource to be distributed as broadly as feasible. Any geographic constraints pertaining to the principles of organ distribution must be rationally determined and consistently applied.

 

Geographic distribution may be constrained in order to:

1. Reduce inherent differences in the ratio of donor supply and demand across the country
2. Reduce travel time expected to have a clinically significant effect on ischemic time and organ quality
3. Increase organ utilization and prevent organ wastage
4. Increase efficiencies of donation and transplant system resources

These principles were recommended by the Ad Hoc Geography Committee, which the Board formed in December 2017 to study the issue and make recommendations. The committee will seek public feedback beginning in August on three potential frameworks it has recommended (fixed distance from donor hospital, mathematical optimized distribution areas and borderless distribution), consistent with the principles, that may be used as a basis for future organ distribution policy. Also, at the committee’s recommendation, the Board called for an analysis of current organ distribution policies in reference to the approved principles. The OPTN/UNOS Executive and Policy Oversight Committees may use this analysis to prioritize the future work of relevant committees.

“Among various issues relating to the impacts of organ allocation policies, the Board had a robust discussion of potential effects on vulnerable populations as addressed in federal law and regulation,” added Dr. Becker. “These do not conflict with the geographic distribution principles as approved, and the OPTN will also assess these issues on an ongoing basis.”

The Board also voted to retain the lung distribution policy adopted on an emergent basis in November 2017 by the OPTN/UNOS Executive Committee, while adding a policy option to provide exception priority for highly sensitized lung candidates. The policy removed the local Donation Service Area as the first level of lung distribution, instead establishing the first level as transplant centers located within 250 nautical miles of the donor hospital. This policy will continue to be examined in light of the newly adopted principles of geography.

In other key actions:

• The Board adopted revisions to OPTN bylaws that outline the process for review of member organizations for compliance with OPTN requirements and for addressing potential issues of quality or patient safety. The revisions clarify the review process and resolve some potentially conflicting details in the prior bylaws.
• The Board also approved revisions to OPTN requirements for informed consent regarding diseases that may be transmitted from donor to the potential recipient; the updates reduce ambiguity in the medical conditions and test results to be addressed and the processes involved in communication.

The Organ Procurement and Transplantation Network (OPTN) brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy. United Network for Organ Sharing serves as the OPTN under contract with the Department of Health and Human Services, Health Resources and Services Administration.