At a glance
What is current policy and why change it?
The Organ Procurement and Transplantation Network (OPTN) requires transplant hospitals to submit information about living organ donors through a living donor registration form and a living donor follow-up form to promote living donor and transplant recipient safety. This is not required for living Vascularized Composite Allograft (VCA) donors, including uterus donors. Because living donor uterus transplants are increasing, and other types of living VCA donation may begin, it is important to collect this information.
Modify Data Collection on VCA Living Donors
Dr. Bohdan Pomahac, Chair of the Vascularized Composite Allograft Transplantation Committee, reviews the policy proposal to Modify Data Collection on VCA Living Donors.
Terms you need to know
- Vascularized Composite Allograft (VCA): Transplant of multiple structures, which may include connective tissue, skin, bone, muscles, blood vessels, and nerves. For example, face and hand transplants are two of the most well-known types of VCA transplants.
- Living donor: A living individual from whom at least one organ is recovered for transplant.
What’s the proposal?
- Require specific information after living VCA donation is complete on the living donor registration form
- Includes related health information about the donor, details about the surgery, and complications around the time of surgery
- Require specific information at six months, one year, and two years after the living VCA donation on the living donor follow-up form
- Includes complications after surgery
- Updates policy to reflect that data related to living VCA donation will be collected in the OPTN computer system, UNet
What’s the anticipated impact of this change?
- What it’s expected to do
- Collect data for all living donors
- Assess patient safety for VCA donors and recipients
- Make sure that living VCA donors have regular checkups after donation
- Require same forms that are used for all other living donors
- What it won’t do
- Change information that is currently required for living organ donors other than VCA
Themes to consider
- Safety of living VCA donors
- Safety of recipients of living VCA donor organs
This proposal is related to two other proposals that have been released for public comment this cycle. These three proposals are summarized below.
|Modify Living Donation Policy to Include Living VCA Donors
Sponsor: Living Donor Committee
|Modify Data Collection on VCA Living Donors
Sponsor: VCA Transplantation Committee
|Programming VCA Allocation in UNet
Sponsor: VCA Transplantation Committee
Another proposal sponsored by the VCA Transplantation Committee, Update to VCA Transplant Outcomes Data Collection, was approved by the Board of Directors in June 2020 and modifies data collection for VCA transplant recipients. Updates to VCA transplant program membership requirements and the list of covered body parts pertaining to VCA were previously approved by the OPTN Board and are also pending implementation. A summary of these changes is available in a combined policy notice.
All of these proposals will be implemented together with a target completion date of June 2022 for the full body of work.
Status: Public Comment
Sponsoring Committee: Vascularized Composite Allograft Transplantation Committee
Strategic Goal: Promote living donor and transplant recipient safety
Region 4 | 08/26/2020
Region 4 vote: 4 Strongly Support, 9 Support, 9 Neutral/Abstain, 1 Oppose, 0 Strongly Oppose This proposal was on the non-discussion agenda for the regional meeting.
Region 5 | 08/28/2020
Region 5 vote: 3 Strongly Support; 23 Support; 4 Neutral/Abstain; 0 Oppose; 0 Strongly Oppose. No comments
OPTN Transplant Coordinators Committee | 09/02/2020
The Transplant Coordinators Committee is in support of this proposal. The TCC feels that in the setting of increasing volumes of living VCA donation, this proposal would potentially improve the OPTNs ability to monitor patient safety. The committee felt that post donation monitoring is critical to monitor the long term safety of these transplants as well as to help monitor donor characteristics that are linked to poorer recipient outcomes. Given the additional data that would be reported, the committee sought clarification regarding the timing of consent for living VCA donors. VOTE: 3 Strongly support, 5 support, 1 neutral/abstain, 0 oppose, 0 strongly oppose
Region 7 | 09/10/2020
Region 7 vote: 3 Strongly Support, 8 Support, 3 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose No Comments
Region 3 | 09/15/2020
OPTN Vascularized Composite Allograft Transplantation Committee: Modify Data Collection on Living VCA Donors Region 3 vote: 1 Strongly Support, 13 Support, 11 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose This proposal was on the non-discussion agenda for the regional meeting.
Living Donor Committee | 09/21/2020
The OPTN Living Donor Committee thanks the OPTN VCA Committee for inviting feedback on the Modify Data Collection on Living VCA Donors public comment proposal. The Committee strongly supports the proposal and appreciates the VCA Committee’s efforts to align data collection requirements with the establishment of VCA in living donor policy. The Committee recommends ensuring the data elements being added are clear and not redundant of other data fields already existing on the LDF. The Committee indicated the following sentiments for the proposal: 4 Strongly Support, 6 Support, 1 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose.
Region 8 | 09/22/2020
Region 8 vote: 4 strongly support, 9 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose
American Society of Transplantation | 09/24/2020
The American Society of Transplantation supports this proposal in concept. We appreciate this work to bring VCA living donations in line with requirements for all other living donors, including the collaboration of the UNOS VCA, Living Donor and Ethics Committees. We recognize the policy language for required data collection for living VCA donors as an important advance over the current voluntary data submission process for living VCA donors. This data collection will be important for the ongoing monitoring of VCA living donors. We see no reason for it to be any different than any other living donor. Also, because the LD VCA case numbers are small, this should not add burden to the Transplant Center’s Data and Quality team. We offer the following comments for the committee’s consideration: • For VCA living donor data collection requirements, consider adding intraoperative complications including anesthetic complications under surgical information for all VCA donors (as currently collected for living lung donors). • Likewise consider adding post-operative complications during the initial hospitalization under Post-operative information for all VCA donors (as currently collected for living lung donors). • We would favor the collection of “new onset psychological symptoms” for all VCA donors, not limited to uterus donors only. Non-uterine VCA donors are uncommon, so this will not pose a large data collection burden but may be relevant to understanding outcomes as practice evolves. The data collection would also align with disclosure in the informed consent policy that there may be potential psychosocial risks of living VCA donation. Accordingly, over time, this may help centers provide more quantitative information in their risk disclosure. • We suggest the following additions for data collection regarding infectious disease • Syphilis screening for uterus donor • Treatment history for sexually transmitted infections of uterus donor, in particular Gonorrhea/Chlamydia (due to the possibility of drug resistance) • We suggest that specific data points may be more beneficial with granular detail, such as: Equivocal results should be an option for certain screening serologies (e.g. Toxoplasma IgG and HSV1/2 IgG ) and The source of the sample for Gonorrhea/Chlamydia NAAT should be specified
Region 1 | 09/24/2020
Region 1 vote: 4 Strongly Support, 5 Support, 2 Neutral/Abstain, 1 Oppose, 0 Strongly Oppose Comments: No Comments
Region 2 | 09/25/2020
Region 2 vote: 5 Strongly Support, 14 Support, 11 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose Comments: No comments