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An important message from the MPSC on the upcoming eGFR waiting time modifications deadline and other updates

Published on: Friday, December 8, 2023

For the benefit of the transplant community, the OPTN Board has authorized the OPTN Membership and Professional Standards Committee (MPSC) to disseminate learnings and effective practices observed during MPSC meetings and interactions with OPTN members. Updates will be provided by the MPSC after each of their in-person meetings.

The Organ Procurement and Transplantation Network (OPTN) Membership and Professional Standards Committee (MPSC) recently communicated to a large segment of OPTN members about several recommendations and opportunities for improvement in processes and protocols related to organ recovery and transplant:

  • Upcoming eGFR deadline
  • Standard packaging for kidneys
  • Responsibility for reporting third party vendors
  • Responsibilities of procurement teams and emphasizing communication

The MPSC is currently working on a number of initiatives which include:

  • Preparing for the implementation of the Required Reporting for Patient Safety Events policy proposal which was approved by the OPTN Board on December 4
  • Preparing a concept paper for Winter 2024 public comment on new OPO Performance Metrics
  • Reviewing data on the outcomes of the Transplant Program Performance Monitoring Enhancement, in addition to regular performance monitoring
  • Reviewing allocation out of sequence (AOOS) data
  • Considering preliminary membership revision
  • Ongoing compliance and safety reviews

These are areas of particular focus due to the risk they present to patient safety and public health, and the MPSC sees opportunities for improvement, support and oversight.

The MPSC is an operating committee of the OPTN Board of Directors. In addition to monitoring for compliance with OPTN Final Rule, policies, and bylaws, the committee supports members through peer review and sharing of effective practices. Find the MPSC’s community updates and other materials on the MPSC resources page.

Upcoming eGFR deadline

On January 3, 2024, all kidney programs are required to have completed all requirements outlined in OPTN Policy 3.7.D. All kidney programs, including pediatric programs, are required to submit attestation documentation to the OPTN, regardless of whether they have Black patients impacted by the use of a race inclusive eGFR calculation. On January 4, the OPTN will request information about a program’s progress and an explanation of the failure to comply. Members will have one week to respond, and the MPSC will review the responses and take appropriate action. The MPSC will review all instances of noncompliance and is willing to take any action available under Appendix L of the OPTN Bylaws. Extensive resources on this requirement and deadline can be found on the OPTN website.

Standard packaging for kidneys

OPOs are expected to maintain verifiable processes and documentation for identifying and labeling kidney laterality. Best practices for consistency and uniformity can be found here, and are highlighted below:

Marking laterality

  • Kidney laterality should be marked during the recovery surgery
  • Marking should clearly identify the left kidney
  • It is recommended that the marking be placed in situ

Pre-Packaging Confirmation of Kidney Laterality

  • It is recommended that OPOs incorporate a mechanism to crosscheck that laterality marking is accurate before the kidney is packaged
  • Double verification practices should be utilized (Examples, a second set of eyes, calling a time out, packaging one organ at a time.)
  • Additional quality checks may include post-case chart audits to confirm that correct procedure was completed and documented

Responsibility for reporting third-party vendors

Reporting issues and concerns to the Patient Safety Portal remains paramount for the integrity of the system. As such, it is important that if an issue with a third-party vendor arises during transplantation, it is the responsibility of the OPTN member to report the instance to the OPTN. The member is responsible for the actions of the third-party vendor while using them for transplant related services.

Responsibilities of procurement teams and emphasizing communication

While it remains the responsibility of the host OPO to ensure organ procurement quality per OPTN Policy 2.14.C, it is increasingly common to have transplant program procurement teams present in the operating room for organ recovery and ex vivo organ profusion. Communication between the visiting teams and the host OPO is vital to ensure that organ procurement quality criteria are met including:

  • All medication used in deceased donor procurement is unexpired, administered at appropriate times, and documented
  • Flush solutions, additives, and preservation media are maintained at appropriate temperatures and documented

When visiting procurement teams bring materials and equipment into the recovery operating room, procurement teams are expected to complete a self-review of these criteria to share with the host OPO. The host OPO is presently responsible for the events in the operating room and procurement teams should be responsive to the requirements of the host OPO. If issues do arise in the operating room that impact organ procurement quality, it is the responsibility of the host OPO to report incidents in the Patient Safety Portal.

For questions or comments regarding this communication, please email MQFeedback@unos.org