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Distribution of Kidneys and Pancreata from Alaska

Proposal Overview

Status: Board Approved

Sponsoring Committee: Kidney Transplantation and Pancreas Transplantation

Strategic Goal: Promote the efficient management of the OPTN

Read the proposal (PDF; 01/2020)

View the Board Briefing Paper (PDF; 6/2020)

View the Policy Notice (PDF; 6/2020)

Contact: Tina Rhoades

eye iconAt a glance

What is current policy and why change it?

Deceased donor kidneys and pancreata from donors in Alaska are first offered to candidates in a designated Donation Service Area (DSA), which helps prevent the organ traveling further to go to a patient in similar need. A new policy will replace DSA with a 250 nautical mile circle around the donor hospital. When this changes, because there are no transplant hospitals in Alaska, there will not be any transplant hospitals located within 250 nautical miles of donor hospitals in Alaska. Without a policy change, all organs procured in Alaska would be offered nationally, which could create inefficiencies in organ placement. This means that these organs could be offered to a patient in Florida before a very similar patient in California if not addressed by a modification of policy.

What’s the proposal?

  • The Seattle-Tacoma International Airport (Sea-Tac) would be a substitute for the donor hospitals in Alaska as the center of the 250 nautical mile circle.

What’s the anticipated impact of this change?

  • What it’s expected to do
    • Promote the efficient placement of kidneys and pancreata from donors in Alaska.
  • What it won’t do
    • Affect the placement of organs donated anywhere other than Alaska.

Themes to consider

  • How this would impact efficient placement of organs.

Terms you need to know

  • Donation Service Area: The geographic area designated by the Centers for Medicare and Medicaid Services (CMS) that is served by one organ procurement organization (OPO), one or more transplant hospitals, and one or more donor hospitals.
  • Donor hospital: The hospital where the deceased or living donor is admitted.
  • Nautical mile: Equal to 1.15 miles and is directly related to latitude and longitude; used in aviation.
  • Click here to search the OPTN glossary.

Comments

OPTN Region 6 | 02/18/2020

Strongly support (8), Support (8), Neutral/Abstain (0), Oppose (0), Strongly Oppose (0) The region strongly supported the proposal. There was a comment that this policy aligns with the liver policy, which is a good thing. There were over 40 donors from Alaska in 2019, which was more than some OPOs, so this is not an insignificant number. This is a good policy for the region and for the potential candidates in the community at-large.

OPTN Region 8 | 02/18/2020

Kidney Transplantation and Pancreas Transplantation Committees: Distribution of Kidneys and Pancreata from Alaska No feedback Vote: 8 Strongly Support, 12 Support, 3 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose

LifeCenter Northwest | 02/18/2020

We support this proposal from the OPTN Kidney Transplantation Committee and OPTN Pancreas Transplantation Committees to use the Seattle-Tacoma International Airport (Sea-Tac) as a virtual location for donor hospitals in Alaska as the center of the 250 nautical mile circle for purposes of allocation of deceased donor kidneys and pancreata from donors in Alaska. This is consistent with the following provision in the Acuity Circle Liver and Intestine allocation policy: 9.10.C Location of Donor Hospitals - For the purposes of determining the location of the donor hospital, livers, intestine, and liver-intestine organs procured in Alaska will be considered procured from the Seattle Tacoma Airport, Seattle Washington. As described in this proposal, it will promote the efficient placement of kidneys and pancreata from donors in Alaska, since there are no transplant programs in Alaska. Without this modification, all kidney and pancreas offers from Alaska donors would first be offered nationally, and utilization could be negatively impacted, since these organs already accrue cold ischemic time over the straight flight distance from Anchorage to Seattle which totals over 1,250 nautical miles. It is worth noting that in the previous public comment process with respect to the proposal to change kidney allocation policy, the OPTN Minority Affairs Committee stated concerns that Alaska donors would go straight to national allocation, and that this could potentially be an inefficient allocation method. This proposal addresses this concern from the MAC. Finally, we support the proposed plan for post-implementation monitoring, which we believe is an important component of any change in allocation policy. Thank you for the opportunity to comment on this proposal.

Region 4 | 02/20/2020

Strongly support (10), Support (12), Neutral/Abstain (2), Oppose (0), Strongly Oppose (0)

Region 5 | 02/21/2020

Strongly support (11), Support (22), Neutral/Abstain (1), Oppose (0), Strongly Oppose (0) No comments or questions Region 5 supported this proposal

Region 2 | 02/28/2020

6 Strongly Support, 18 Support, 5 Neutral/Abstain, 2 Oppose, 0 Strongly Oppose Members of the region supported the proposal. One member commented that the two committees should monitor utilization of kidneys and pancreata from Hawaiian donors and consider a similar solution. Even though Hawaii does have a transplant hospital the committees a similar solution might be necessary to increase utilization.

Region 1 | 03/10/2020

Strongly support (3), Support (8), Neutral/Abstain (0), Oppose (0), Strongly Oppose (0) Region 1 fully supports this proposal No comments or questions

Minority Affairs Committee | 03/17/2020

“The Minority Affairs Committee (MAC) appreciates the opportunity to provide feedback on “Distribution of Kidneys and Pancreata from Alaska”. The MAC strongly supports this proposal. The Committee agrees that the Seattle- Tacoma airport should serve as the substitute for the donor hospitals in Alaska in an effort to efficiently place kidneys and reduce the amount of cold ischemic time on these organs.”

American Nephrology Nurses Association (ANNA) | 03/18/2020

ANNA supports this proposal.

Region 11 | 03/19/2020

Strongly support (9), Support (10), Neutral/Abstain (2) Oppose (0), Strongly Oppose (0) Region 11 fully supports this proposal and agrees that it achieves the purpose of removing inefficiency.

OPTN Region 3 | 03/22/2020

No comments Vote: 3 strongly support, 12 support, 3 neutral/abstain, 1 oppose, 0 strongly oppose

NATCO | 03/23/2020

NATCO strongly supports a solution to avoid a negative impact on utilization, and promote the efficient placement of organs recovered in Alaska by administratively allocating kidney and pancreata from Alaska as though they were recovered in Seattle. We agree to the use of Seattle-Tacoma International Airport as the substitute for the donor hospitals in Alaska as the center of the 250 nautical mile circle. We agree that this solution should decrease cold ischemic time and promote greater utilization of these organs.

American Society of Transplant Surgeons | 03/23/2020

The American Society of Transplant Surgeons (ASTS) supports this proposal as written. We recommend the OPTN take an iterative approach to all new organ allocation policies by taking small steps with regular reassessments (e.g., one year) to identify successes and unintended consequences, particularly concerning logistical issues. Modifications are needed to the new allocation policy for donated kidneys and pancreata from Alaska: to address the absence of a transplant hospital within 250 nautical miles (NM), to promote efficient organ placement, and to prevent organ loss. ASTS agrees with the proposal to designate the Seattle-Tacoma Airport (SeaTac) as the “administrative” center for Alaska’s allocation circle with two proximity points inside and four points outside the circle. We recommend however that the OPTN extend the circle to 500NM to increase the chance for placement.

OPTN Operations & Safety Committee | 03/23/2020

The Operations and Safety Committee (OSC) thanks the OPTN Kidney Transplantation Committee for their efforts in developing this public comment proposal for the Distribution of Kidneys and Pancreata from Alaska. The Committee indicated the following sentiments for the proposal: 46% Strongly Support, 54% Support, 0% Neutral/Abstain, 0% Oppose, 0% Strongly Oppose

OPTN Organ Procurement Organization (OPO) Committee | 03/23/2020

The OPO Committee supported this proposal. One committee member asked if there were transplant hospitals in other regions that were in a similar situation due to their remote location and whether this could potentially be extended to other regions in the future.

American Society of Transplantation | 03/23/2020

The American Society of Transplantation supports this proposal without further comment.

OPTN Region 9 | 03/24/2020

Strongly support (5), Support (7), Neutral/Abstain (1), Oppose (0), Strongly Oppose (0) The region supports the proposal, and there were no comments.

Region 10 | 03/24/2020

11 Strongly Support, 11 Support, 2 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose Members of the region supported this proposal. One member mentioned that the committee may want to consider similar proposals for donors from Hawaii and Puerto Rico. It was noted that both Hawaii and Puerto Rico do have transplant programs unlike Alaska.

Region 7 | 03/24/2020

8 Strongly Support, 4 Support, 0 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose No comments