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Eliminate the use of DSA and Region in pancreas allocation policy

Proposal Overview

Status: Public Comment

Sponsoring Committee: Pancreas Transplantation Committee

Strategic Goal: Provide equity in access to transplants



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Read the proposal (PDF; 8/2019)

Kidney and Pancreas Distribution Modeling: Analysis at a Glance (8/2019)

Contact: Ross Walton

eye iconAt a glance

You may be interested in this proposal if

  • You or your loved one needs a pancreas or kidney-pancreas (KP) transplant
  • You are a healthcare professional who cares for patients with diabetes or pancreatic exocrine insufficiency
  • You work for a pancreas transplant program or an Organ Procurement Organization (OPO)

Here’s what we propose and why

The OPTN Pancreas Transplantation Committee proposes to remove Donation Service Area (DSA) and regional boundaries used in the current system and allocate using a 500 nautical mile (NM) circle around the donor hospital. Points would be assigned based on how close the candidate’s transplant hospital is to the hospital where the organ donation takes place. This is to prevent a pancreas or kidney-pancreas being transported further away when there is a candidate of similar priority closer to the donor hospital. The pancreas and kidney-pancreas would first be allocated to all eligible candidates inside the 500 NM circle. If the organ has not been accepted by those candidates, it would then be offered to other eligible candidates.

Location should not impact access to transplant except to promote efficient organ placement and to prevent unnecessary organ loss.

Why this may matter to you

The proposal aims to increase equity for U.S. pancreas and kidney-pancreas transplant candidates by reducing the impact that a patient’s location has on their access to transplant. Certain areas of the country will see an increase in the number of transplants and other areas will experience a decrease. Some pancreata and kidney-pancreata will have to travel further than they do in the current system. This will result in new working relationships between OPOs and transplant centers.

Tell us what you think

  • What considerations should be taken into account to select a circle size that distributes pancreata broadly and efficiently?
  • Proximity points are intended to contribute to efficiency in the broader distribution of pancreata. Should they be used inside the 500 NM circle? Should they be used outside the 500 NM circle?
  • What operational concerns should the Committee consider as this policy is being prepared for OPTN board action and implementation?
  • For import back up, should the initial distance from the transplant program be 150 NM or another distance, when considering the efficient reallocation of pancreas and kidney-pancreas? Should proximity points be included outside the initial import match run circle to limit travel costs and preservation time, or should there be a secondary circle of 500 NM to address those concerns?
  • Should programs qualify for facilitated placement if the program performs 2 or 5 transplants in 2 years from pancreata imported beyond 500 NM from the transplant program?  

Comments

LifeGift | 08/08/2019

Broader distribution is supported by LifeGift. Any improvements in the current pancreas allocation and distribution system are welcome changes to help address the extreme underutilization of donated pancreata. Thank you for the chance to comment.

Wake Forest Baptist Health | 08/13/2019

I don't disagree with the hybrid framework model to replace DSA as a method of pancreas distribution but the 500 NM radius is much too large. When I use the interactive map and use our center (NCBG) as the donor hospital, the distribution/proximity circle in essence encompasses nearly all of the continental US east of the Mississippi River! This represents much too large of a geographic area in order to facilitate efficient placement and transplantation of recovered pancreata, particularly given the constraints of cold ischemia in pancreas transplantation. The logistics involved in such an undertaking are staggering, cumbersome, and counterproductive to optimal utilization of donor pancreata. I would favor lowering the proximity circle to either 150 or 250 NMs. With respect to import pancreata and facilitated pancreas allocation, I would suggest removing the qualifying criteria because you are increasing the definition of "local". Local back-up should be center back-up, again because of cold ischemia considerations. Trying to re-allocate a KP at another center is a near-futile proposition. Pediatric priority should be added to pancreas allocation.