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OPTN/UNOS Board adopts principles of geographic organ distribution

Jun 12, 2018 | News

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:

Reduce inherent differences in the ratio of donor supply and demand across the country

Reduce travel time expected to have a clinically significant effect on ischemic time and organ quality

Increase organ utilization and prevent organ wastage

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.

UNOS announces 2018 National Donor Memorial Award winner

Jun 11, 2018 | Get involved, News, Patient

United Network for Organ Sharing (UNOS) named Terry Murray of Olney, Md., the winner of its 2018 National Donor Memorial Award for Excellence in recognition of her untiring efforts as a donation advocate. Terry has long understood the importance of organ donation and transplantation. Her mother donated a kidney to her brother in 1977. Twenty-two years later Terry’s husband, Alan, died from a tragic fall and became a tissue donor. Donation helped Terry and her children cope with their loss.

When Terry retired from teaching school in 2003, she felt compelled to educate high school students about what it means to be a donor. Every year Terry presents to all 26 Montgomery County, MD., high schools. In the past 15 years, she has volunteered almost 1,000 hours to promote donation. “Educating young people about the importance of organ, eye and tissue donation is essential to increasing the number of lives saved through organ transplantation,” said UNOS President Yolanda Becker, M.D. “Terry’s continued work with Maryland high school students has directly increased donor registrations in the state.” UNOS established the National Donor Memorial Award for Excellence in 2010 to recognize exceptional advocates who promote organ donation and transplantation. UNOS solicits nominations for the award from the organ procurement organizations and transplant centers in the United States. Terry was nominated by Washington Regional Transplant Community.

Previous winners have been donor family members, a social worker/donation advocate, a liver recipient, and the sister of a heart recipient. UNOS, a private, nonprofit organization, unites and supports the organ donation and transplantation community nationwide through organ placement, research, technology, policy development and education. UNOS serves as the nation’s Organ Procurement and Transplantation Network (OPTN) under federal contract. As the OPTN, it matches lifesaving organs with people awaiting transplants nationwide and manages the national database of medical information about transplant candidates, recipients, and donors. Headquartered in Richmond, Va., UNOS is also home to the National Donor Memorial, which honors the life-giving impact of organ and tissue donation.

New booklet advises parents of pediatric transplant patients

Apr 24, 2018 | Education, Patient News, Transplant center

A new resource booklet, “What Every Parent Needs to Know,” is available for parents and caregivers of children and adolescents who need or receive an organ transplant. The OPTN/UNOS Patient Affairs Committee spearheaded the booklet’s development in collaboration with a number of transplant professionals and parents of organ transplant recipients*.

The booklet explains the transplant process from a parent’s viewpoint. It addresses issues before and during a transplant such as financial concerns and explaining deceased donation to a child, as well as guidance on helping children manage life after a transplant. It addresses a number of concepts and terms relating to transplantation and provides references to other helpful resources.

* The Patient Affairs Committee also wishes to thank the following organizations for reviewing the booklet:

American Liver Foundation
American Society of Transplantation
Anne & Robert H. Lurie Children’s Hospital of Chicago
Children’s Cardiomyopathy Foundation
Children’s Organ Transplant Association
International Pediatric Transplant Association
National Kidney Foundation
Pediatric Heart Transplant Study

UNOS celebrates 34th anniversary founding

Mar 13, 2018 | News

United Network for Organ Sharing (UNOS) was founded March 21, 1984, by the leadership of the South-Eastern Organ Procurement Foundation (SEOPF). UNOS was intended to become the nation’s organ transplant network, an idea that was still in development as Congress worked on the National Organ Transplant Act. To some degree, it was a leap of faith, given that the eventual contract for the Organ Procurement and Transplantation Network (OPTN) wasn’t awarded until two years later.

In the early 1980s, organ transplantation in the United States was evolving rapidly. The pioneers of transplantation had proven that it could save and lengthen lives. But much of the science of transplantation and medical management of transplant recipients was still developing. And many transplant programs were just beginning to open up, increasing local access to care for patients across the country.

Some transplant professionals wanted to keep the field much as it had been since the 1960s. Others, including the founders of UNOS, saw the need to bring the field together in a national network, both to increase equity for transplant patients and to collect and use national data to improve transplant care. Even today, there remains healthy debate inside and outside the transplant profession about how we can best meet the needs of the patients we serve.

In the 34 years since UNOS’ founding, many things have changed. Long-term outcomes for transplant recipients have increased significantly, driven by better knowledge about matching donors with recipients and advances in treating patients both before and after the transplant. Innovations in communications technology and data analysis have revolutionized how organ offers are made and what information clinicians have in real time to make treatment decisions.

Some things remain the same. Transplantation is still the most complex form of medical care available. It relies on the cooperative efforts and skill of clinicians and professionals at different institutions anywhere in the United States, working at any hour of the day or night. And despite everyone’s best efforts, there are still many more people awaiting transplantation today than there are donated organs to meet their needs.

UNOS’ mission also remains the same, as does the focus and dedication of its staff and members. We do all we can to help those in need receive the gift of life. And we will continue to do so as long as that need exists.

Public comment sought

Jan 22, 2018 | Patient News, Policy

The Organ Procurement and Transplantation Network (OPTN) offers policy proposals for public comment from January 22 through March 23, 2018.

Comments and replies will be published on the OPTN public comment page, to promote transparency and trust in the national transplant system. Visitors can also share comments on social media, if they wish.

Feedback for selected proposals will be sought via a response form. This is part of a trial to study potential enhancements to the public comment process. For the proposals using the response form, the comments related to the proposal will be displayed on the public comment page in the same manner as the blog-style responses to all other proposals.

One of the proposals is a draft of an updated OPTN/UNOS strategic plan. The plan, to be finalized by the OPTN/UNOS Board of Directors after public input, will serve as a roadmap to help prioritize the OPTN’s work through 2021 and provide metrics to assess progress toward key goals.

We encourage patients, transplant candidates and recipients, living donors, donor families and transplant professionals to learn more about the proposals below and provide valuable feedback to help shape U.S. organ transplant policy:

Aligning VCA program membership requirements with other transplant programs
Modifications to the distribution of deceased donor lungs
Clarifying informed consent policies for transmissible disease risk
Concept paper on expedited organ placement
Reducing reporting burdens and clarify policies on extra vessels
Guidance on optimizing VCA recovery from deceased donors
Changes to waiting time criteria for kidney pancreas candidates
Modifying the lung Transplant Recipient Form to improve post-transplant lung function data
Revising OPTN Bylaws Appendix L
White paper on manipulating waitlist priority
Guidance for ABO subtyping of Blood Type A and AB organ donors
Concept paper on improving the OPTN/UNOS committee structure
Guidance on deceased donor requested information
OPTN/UNOS strategic plan
Review board guidance on heart candidates with exceptions for HCM and RCM

Deceased organ donors in United States exceeded 10,000 for first time in 2017

Jan 9, 2018 | News, OPO

During 2017, the number of deceased organ donors in the United States topped 10,000 for the first time, 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. For the year, organs were recovered from 10,281 donors, representing a 3.1 percent increase over 2016 and an increase of 27 percent since 2007.

A total of 34,768 organ transplants were performed in 2017 using organs from both deceased and living donors, according to preliminary data. This total is a 3.4 percent increase over 2016 and marks the fifth consecutive record-setting year for transplants in the United States. Record number of donor organs were recovered and transplants occurred for each of the four most common organs transplanted – kidney, liver, heart and lung.

“We are grateful that more lives are being saved, year after year, thanks to the boundless generosity of organ donors,” said Yolanda Becker, M.D., president of the OPTN/UNOS Board of Directors. “We remain committed to increasing the number of transplants still further to help the many thousands of people in need of a transplant to sustain them and vastly improve their quality of life.”

Approximately 82 percent (28,587) of the transplants performed in 2017 involved organs from deceased donors. Living donor transplants accounted for the remaining 18 percent (6,181). In the 30-year span from 1988 (the first full year national transplant data were collected) through 2017, a total of 721,742 transplants have been performed nationwide.

While the number of potential 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, 35 (60 percent) experienced an increase in donors from 2016 to 2017, including at least one OPO in each of UNOS’ 11 regions.

“Donation and transplantation continues to increase across the country,” said Brian Shepard, Chief Executive Officer of UNOS. “We are working with donation and transplantation professionals nationwide to help identify additional transplant opportunities and enhance the efficiency of the organ acceptance process.”

Broadening of clinical criteria for potential donors accounts for some of the ongoing increase in deceased organ donation and transplantation. In 2017, as compared to 2016, a higher proportion of donors had medical characteristics such as donation after circulatory death as opposed to brain death, drug intoxication as a mechanism of death, age of 50 or older, and/or being identified as having increased risk for blood-borne disease.

“As we increase our understanding of medical criteria that contribute to successful transplantation, donation and transplantation professionals have been able to use organs from a wider set of potential donors,” said David Klassen, M.D., UNOS Chief Medical Officer. “In doing so, we continue to carefully balance the opportunity for transplantation with a commitment to maintaining patient safety.”

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