Status: Board Approved
Sponsoring Committee: Vascularized Composite Allograft Transplantation Committee
Strategic Goal 2: Provide equity in access to transplants
View the Board report (PDF - 1 M; 6/2019)
Read the proposal (PDF; 1/2019)
Contact: Christopher Wholley
The OPTN/UNOS Final Rule (hereafter Final Rule) sets requirements for allocation polices developed by the OPTN/UNOS, including sound medical judgement, best use of organs, ability for transplant programs to decide whether to accept an organ offer, avoiding wasting organs, and promoting efficient management of organ placement. The Final Rule also includes a requirement that allocation policies “shall not be based on the candidate’s place of residence or place of listing, except to the extent required” by the other requirements.
On July 31, 2018, the Secretary of Health and Human Services (HHS) found that the use of donation service areas (DSAs) or regions in organ allocation policies cannot be justified under the Final Rule. OPTN/UNOS policies for vascularized composite allograft (VCA) allocation use “region” as the first geographic boundary for distribution. In response to the Secretary’s letter, the OPTN/UNOS Executive Committee directed the VCA Transplantation Committee (Committee) to develop a proposal that replaces “region” with another geographic boundary in VCA allocation policy. This proposal would replace use of regions in VCA allocation policies with a 750 nautical mile (NM) concentric circle around a donor hospital. This will address the Secretary’s findings by allowing efficient placement of deceased donor VCAs, help achieve optimal recipient and graft outcomes, and to reduce the risk of organs being recovered but not transplanted.
This proposal is consistent with Goal Two of the OPTN/UNOS Strategic Plan to increase equity in access to transplant. This project aims to implement rational units for geographic distribution that are more consistent with the requirements of the Final Rule.
The Committee encourages all interested individuals to comment on the proposal in its entirety. Members are asked to comment on both the immediate and long-term impact on budgets and other resources that may be required if this proposal is approved; this information assists the Board in considering the proposal and its impact on the community. The Committee requests specific feedback on the following items:
- Members are asked if they would recommend an alternative distance for VCA distribution, versus the proposed distance of 750 NM? If so, what distance do you recommend and what evidence justifies this distance?