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Guidance on effective practices in broader distribution

Proposal Overview

Status: Public Comment

Sponsoring Committee: Operations and Safety Committee

Strategic Goal 5: Promote the efficient management of the OPTN

Read the proposal and guidance (PDF; 1/2019)

Contact: Robert Hunter


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Executive summary

The OPTN/UNOS Operations and Safety Committee created a guidance document to provide effective practices as well as operational and process recommendations. The intent of this guidance is to help OPTN members adapt to policy changes that address the broader distribution of organs. These allocation changes impact all members in the organ donation and transplantation community and will require operational changes to increase the efficiency of organ allocation, donor and recipient matching, transportation logistics, and organ recovery.

The guidance document is intended to serve as a resource for OPTN members. The scope and content should reflect collaboration between OPOs, transplant hospitals, and histocompatibility labs, taking into consideration their needs and best practices.

Feedback requested

The Operations and Safety Committee is requesting feedback on collecting additional data on the “mode of transportation” for organs. This will help provide data for future broader distribution discussions.

  • Does the transplant community support additional data collection necessary for OPTN Committees to evaluate the logistical impact of broader distribution? For example, collecting information on the “mode of transportation” used to transport organs.

Comments

Jay Blum | 01/27/2019

A nationwide distribution network would allow for an equal opportunity for all patients to potentially receive a transplant. Nationwide distribution will eliminate the vast difference in wait times currently experienced in different regions. A nationwide distribution should reduce the wait times for some regions and raise others but create a national wait time average more in tune with today's transportation logistics.

Ad Hoc Disease Transmission Advisory Committee | 02/08/2019

The Ad Hoc Disease Transmission Advisory Committee (DTAC) values the opportunity to comment on public proposals and, in general, commends efforts to enhance broader organ sharing. DTAC reviews potential donor-derived disease transmission events reported to the OPTN. A number of potential donor-derived transmission events reported are seasonal and geographically associated. As new broader sharing policies are implemented, transplant programs will need to review the OPO’s seasonal and geographic endemic infection screening practices and develop protocols accordingly. Recognition of disease in donors can be challenging. To minimize the risk of disease transmission a proportion of OPOs have instituted seasonal and geographic screening practices. For example, screening for West Nile Virus (WNV) is usually performed during the mosquito seasons. On the other hand, OPO’s with a high proportion of foreign-born donors have chosen to selectively screen for Strongyloides and Chagas infection based on epidemiological risk factors. If broader sharing is achieved, and recipient centers find themselves dealing with more distant OPOs, they will need to familiarize themselves with geographically restricted infections not normally encountered. DTAC is supportive of the proposal, as written, provided that resources are taken during implementation to ensure centers are educated regarding new tests and new conditions they may be exposed to through broader organ sharing.

Region 7 | 02/08/2019

Region 7 vote-1-strongly support, 6 support, 2 abstain, 3 oppose Members opposed to this document agreed that the finance sections that address billing between OPOs and surgeons as well as fair market value are outside of the purview of the OPTN.