Stories

Two-year analysis shows effects of kidney allocation system

Jul 11, 2017 | News

An analysis of data two years since implementation of the kidney allocation system (KAS) shows a number of longer-term patterns, with success in a number of key system goals.

Trends include the following:

Deceased donor kidney transplants have increased 9.1 percent since KAS implementation; deceased donation also has continued to increase substantially from 2014 through 2016. This rise is not necessarily attributable to KAS.
There was no substantial change in transplant volume in any region post-KAS Year 2 versus post-KAS Year 1.
From Year 1 to Year 2 after KAS implementation, the percentage of kidney recipients age 18 to 49 decreased slightly and transplants for recipients age 50 and older increased slightly.
Kidney transplant percentages by recipient ethnicity are now more similar to the ethnic makeup of waiting list candidates. This is a noticeable difference from pre-KAS kidney allocation, and it is one of the expected outcomes of KAS.
Longevity matching (matching kidneys most likely to function the longest with recipients likely to need them the longest) continues to perform as intended. More than half of adult recipients with an Estimated Post-Transplant Survival (EPTS) score between zero and 20 percent (indicating the longest potential need) received kidneys with a Kidney Donor Profile Index (KDPI) score between zero and 20 percent (indicating the longest potential function).
Significant “bolus effects” occurred for candidates who received additional transplant priority under KAS, including those with very high immune sensitivity and those with lengthy dialysis times prior to transplant listing. Many of these candidates received a transplant soon after the new policy was implemented because of the increased priority they received. Transplants have declined as fewer candidates remain on the waiting list, but the percentage of transplants going to these groups is still higher than the rate prior to KAS.
The percentage of transplant recipients experiencing delayed graft function (DGF) increased initially post-KAS but has since declined slightly, though still remains higher than pre-KAS. This finding may be influenced by the bolus effect for recipients who have been on dialysis longer-term.
The kidney discard rate after KAS has also remained higher than the period before KAS implementation – 19.9 percent in Year 2 post-KAS. Discard rates are largely linked to KDPI scores; less than three percent of kidneys with a KDPI of zero to 20 are discarded, compared to 60 percent of kidneys with a KDPI between 86 and 100 percent.
Rates of patient survival under KAS have decreased slightly but remain very high. The overall rate of kidney graft survival (organ function post-transplant) also has shown some decrease. The difference in graft survival rates is affected to some degree by factors such as recipient age and the amount of time the kidney is preserved between recovery and transplantation. Since recipient immune sensitivity and dialysis duration also relate to outcomes, and since more highly sensitized candidates and longer-term dialysis candidates received transplants soon after KAS implementation, the “bolus effects” described earlier may also affect post-transplant patient and graft survival rates.

The OPTN/UNOS Kidney Transplantation Committee will continue to analyze these trends carefully, as well as other data that will be available longer-term.

These recent findings are based on limited data. They must be interpreted cautiously and further tracked to assess whether observed trends will be sustained.

OPTN/UNOS Board approves national board to review exception priority for liver transplant candidates, guidance document for transplant candidate education

Jun 8, 2017 | News

Richmond, Va. – The OPTN/UNOS Board of Directors, at its meeting June 5 and 6, approved a national system to assign liver allocation priority for candidates with exceptional medical conditions.

“While there have been review boards in each region to consider individual exception scores for liver candidates for a number of years, this has sometimes led to differences in how much priority candidates may get from one area to another,” said Stuart Sweet, M.D., Ph.D., OPTN/UNOS Board President. “The new system will create more consistency and will also scale its criteria to balance the priority between exception candidates and those with standard scores. This is a crucial step forward in addressing geographic disparities in liver transplant access. ”

The majority of liver transplant candidates receive an allocation score based on either the Model for End-Stage Liver Disease (MELD) or the Pediatric End-Stage Liver Disease (PELD) model. These scores estimate candidates’ short-term risk of death without receiving a liver transplant. While MELD and PELD provide reliable estimates for most liver candidates, others have diseases or unusual complications that the formulas do not capture as well. These candidates receive an “exception score” comparable to the degree of illness of MELD and PELD candidates.

The newly approved National Liver Review Board (NLRB) will replace the individual review boards in each of the 11 OPTN regions. Reviewers will be drawn from a nationwide pool of liver transplant physicians and surgeons, who will review exception requests on an anonymous basis for candidates not listed at the transplant program of any of the reviewers. The policy also establishes standard allocation point thresholds for a number of common medical conditions needing an exception score, as well as guidance documents for NLRB members to consult when considering a non-standard exception.

While no Board action was planned or taken to address liver distribution, the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee briefed the board on its development of a new policy proposal intended to reduce geographic disparity in liver candidates’ medical urgency scores at transplant. The committee is not currently considering an 8-district concept circulated for public comment in 2016.

In other action, the Board approved a guidance document to help transplant professionals discuss with transplant candidates the option of potentially receiving a transplant from a donor at potentially increased risk for disease transmission based on Public Health Service criteria.

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

UNOS announces national donor memorial award winner

Jun 5, 2017 | Get involved, News, Patient

United Network for Organ Sharing (UNOS) named Alejandra Cortes of Dayton, OR, the winner of its 2017 National Donor Memorial Award for Excellence in recognition of her untiring efforts as a donation advocate. This is the first time in the award’s history that it was bestowed upon the family member of an organ recipient.

Nine years ago Alejandra’s younger brother Jose suffered a heart attack. Although Jose survived the heart attack, a heart transplant saved his life. While recovering from his transplant, Jose asked Alejandra to help him serve his community and give others a second chance at life. The siblings planned a festival where the Spanish-speaking community in Oregon could receive, in a joyful way, information about organ, eye and tissue donation. Alejandra is now the lead organizer for this family event that features live music, games, raffles, face painting, clowns, Zumba, health information, free dental and eye exams, and testimonies about donation. Beginning in 2011, thousands of Oregonians have learned accurate information about donation and transplant for the first time and have taken the step to register donors and educate others in their families.

Alejandra is also a volunteer in Donate Life Northwest’s Spanish outreach program. She attends regular team meetings, shares her story on Spanish-language interviews, recruits new volunteers, and actively teaches people about organ donation through her role as a Health Promoter.

“The hard work of donation advocates makes a huge difference in our ability to increase the number of lives saved through organ transplantation,” said UNOS President Stuart Sweet, M.D. “Alejandra’s hard work educating her community is creating a culture of donation and is what this award is about.”

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. Alejandra was nominated by Donate Life Northwest. Previous winners have been donor family members, a social worker/donation advocate, and a liver 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. Also, it manages the national database of medical information about transplant candidates, recipients and donors.

UNOS has been headquartered in the Richmond area since its founding in 1984. UNOS is also home to the National Donor Memorial, which honors the life-giving impact of organ and tissue donation.

UNOS researchers study equity in access to deceased donor kidney transplants

Jun 2, 2017 | Equity, Kidney/pancreas, News, Research

UNOS staff researchers recently developed a new data report, the Equity in Access Report, to measure how the OPTN system for allocating deceased donor kidneys is meeting the needs of transplant candidates. The framework of the report will help the transplant community continue to track the effects of allocation policies over time and assess the merits of alternative policy proposals in the future. Providing equity in access to transplants is a key goal of the OPTN strategic plan.

UNOS researchers developed the methodology with support from the OPTN contract (Health Resources and Services Administration contract 234-2005-37011C). They also summarized their findings in a presentation at the American Transplant Congress in May.*

The researchers performed regression analysis to predict time to deceased donor kidney transplantation based on 15 individual candidate characteristics, separately for each quarterly time period from January 2010 through March 2016.

The kidney allocation system (KAS) implemented in late 2014 appears to have markedly improved equity in access for kidney transplant candidates. Even with overall improvement, however, remaining disparities are largely attributable to differences in the Donation Service Area where the candidate is listed, as well as the candidate’s blood type and calculated panel reactive antibody (CPRA) profile.

* Stewart, Darren; Wilk, Amber; Cherikh, Wida; Harper, Ann; Urban, Read; Klassen, David; Edwards, Erick; “A New Methodology for Measuring and Monitoring Equity in Access to Deceased Donor Kidney Transplants”, American Transplant Congress, Chicago, 2017.

UNOS again named top workplace

Mar 7, 2017 | News

2017 Richmond Times Dispatch Award
UNOS has been named a Top Workplace program in the Richmond, Va. region. The announcement was made March 6 in the Richmond Times-Dispatch.

For the fourth consecutive year, UNOS is recognized as one of the top 10 among mid-sized companies (125 to 399 employees) based on employees’ responses to an annual survey.

The top winners in each of the four categories based on company size will be announced at the Top Workplace 2017 program May 4 at the University of Richmond and in a special section of The Times-Dispatch to be published May 5.

The program is conducted by the Richmond Times-Dispatch and Workplace Dynamics, LLC.

In Memoriam – Thomas Starzl, M.D.

Mar 6, 2017 | Leadership, News

UNOS shares with the transplant community in remembering and honoring Thomas Starzl, M.D., who passed away March 4, 2017. His achievements are integral to the development of the practice and science of organ transplantation.

Dr. Thomas Starzl, Distinguished Service Professor of Surgery at the University of Pittsburgh School of Medicine. Photo credits: UPMC Media Relations

Thomas Starzl, M.D.

Dr. Starzl will best be remembered as the pioneer of liver transplantation, performing the first successful procedure in 1967 at the University of Colorado. Many of the longest-surviving liver transplant recipients were treated by Dr. Starzl and his medical team. He also helped countless recipients through his pioneering research and clinical work in immunology. He was a champion of the immunosuppressant drug tacrolimus (Prograf) but also led efforts to taper, and in some cases, discontinue immunosuppressant drugs for recipients exhibiting tolerance of their graft.

Dr. Starzl relocated to the University of Pittsburgh Medical Center in 1981 and continued in clinical practice until 1991. In the 20 years following his arrival, the transplant programs at UPMC performed nearly 6,000 liver transplants and more than 11,000 total organ transplants. He continued to conduct research at the University before retiring from active responsibilities in 2008.

He received many prestigious honors for his lifetime body of work, including the Lasker-DeBakey Clinical Medical Research Award, the National Medal of Science and the King Faisal International Prize for Medicine. He was founding president of the American Society of Transplant Surgeons and founding vice president of the International Transplant Society. He also helped found the Transplant Recipients International Organization (TRIO). He volunteered his time and expertise on the OPTN/UNOS Scientific Advisory Committee and the Liver Subcommittee of the OPTN/UNOS Organ Procurement and Distribution Committee.

He authored or co-authored more than 2,000 scientific articles and four books. He also trained and mentored many clinicians who continue in practice today. His legacy will continue to be felt in the field of organ transplantation for decades to come.