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Expedited liver placement

Proposal Overview

Status: Public Comment

Sponsoring Committee: Organ Procurement Organization Committee

Strategic Goal: Increase the number of transplants



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Read the proposal (PDF; 8/2019)

Contact: Pete Sokol

eye iconAt a glance

You may be interested in this proposal if

  • You work for an OPO
  • You work for a transplant hospital
  • You are currently on the liver waitlist

Here’s what we propose and why

Sometimes when OPOs are already in the operating room with the donor, they will hear from transplant centers that they no longer want to receive the liver they accepted for their candidate. When this happens, the OPO has to act quickly to try and place the organ elsewhere. Because we have no current policy in place that specifically addresses this situation, we are proposing an idea that would make it easier for OPOs to place these types of organs quickly and reduce the chance that they are discarded without being transplanted. If transplant centers are interested in receiving an offer of this type, this proposed policy would require them to report specific information in advance. It would also give OPOs specific guidance on how to conduct these cases, including the amount of time the transplant center has to respond, so that all expedited offers are handled consistently and uniformly across the country.

Why this may matter to you

This policy change would give OPOs early access to a list of transplant centers who are interested in accepting this type of offer for their candidate. This means OPOs could begin making back up plans before they ever enter the operating room.

Transplant hospitals would have the opportunity to indicate their willingness to accept an expedited liver offer, but in order to participate they would be required to enter specific acceptance criteria in advance.

Tell us what you think

  • Would this proposal help OPOs more quickly place livers that are turned down in the donor operating room?
  • During a previous public comment, many people were concerned that initiating expedited placement in the donor operating room was too late in the process. Does allowing OPOs to identify expedited liver candidates on the original liver match run address that concern?

Comments

Ryutaro Hirose | 08/07/2019

I commend the OPO in codifying the expedited placement process and making it a consistent practice. I personally would have pushed the process back to include a refusal or organ decline within 3 hours of the scheduled OR/withdrawal of support as these are also situations in which time pressure can make expedited placement may need to occur to prevent discard or to at least more efficiently identify a transplant center that will commit to accepting an organ that was declined late in the process and requires late re-allocation. Overall, I support this proposal and look forward to further refinement. I also plead with UNOS to capture all late declines and publish their findings with respect to center frequency or at least have that metric be a component of a transplant center report card that is shared with centers.

Indiana Donor Network | 08/08/2019

We strongly support this policy. This is a great first step for the OPOs to be able to place more livers for transplant under circumstances out of our control once we enter the OR. Having a list of true centers willing to accept livers from these cases is crucial to getting more organs transplanted. UNOS needs to ensure monitoring of this practice to limit abuse of every transplant center agreeing to be on the expedited list but not actually accepting these types of livers as all of the committee's work with be for nothing if the list isn't actually expedited.

LifeGift | 08/08/2019

We support this refined policy proposal as it takes into account the need for transplant program acceptance information prior to the actual decline of the offer to enable the OPO to act quickly in placing a transplantable organ, considered so by some programs and not considered so by others. It will be critical to use clear, consistent terms for monitoring this effort, and transparency in collecting and reporting effective practices to include successful utilization practices. If possible, proceed with some sort of testing the structure and process of the proposed policy to observe for impact before rolling out as a final policy. Thank your for the opportunity to comment.