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Board extends pediatric heart transplant policy

Richmond, Va. -- The OPTN/UNOS Board of Directors, at its meeting Sept. 20, approved a modification of an existing policy that allows heart transplantation in infants with a known blood type mismatch with the donor after all blood-type compatible candidates have been considered. Previous clinical experience has demonstrated that this procedure can be performed with acceptable outcomes in infants less than one year old. The revised policy allows urgent heart transplant candidates up to two years old to be considered for blood type mismatch offers and adds specific monitoring to address patient safety.

"This policy has significant potential impact in terms of organ availability for pediatric heart candidates," said Dr. Stuart Sweet, chairman of the OPTN/UNOS Pediatric Transplantation Committee. "We will monitor its impact to determine whether access to pediatric heart transplantation improves, and we will devote particular attention to patient safety and outcomes."

Given the OPTN's mandate to provide guidance in issues of living donor safety and quality, the Board reviewed processes to study instances of living organ donor deaths or organ failure. Transplant centers are required to notify UNOS expeditiously after such an event, and a review is undertaken of the living donor program involved. The intent of the review is to classify the severity and nature of the event and determine whether additional actions may be taken to improve the safety and quality of living donor procedures.

In other action, the Board adopted position statements highlighting the collective responsibility of the transplant community to develop and maintain public trust in both deceased and living donor transplantation. This includes ensuring that recipients understand the clinical and psychosocial risks and benefits of accepting a given organ offer. The Board also expressed support for the World Health Organization and other international organizations in studying and addressing issues of "transplant tourism" (candidates traveling internationally for transplantation in exploitative circumstances).

The Board additionally approved an OPTN strategic plan and specific short-term goals to address priorities in increasing organ availability, minimizing wait list deaths, optimizing the number of transplants and transplant survival, and maintaining appropriate oversight over the quality and performance of transplant institutions.

The Organ Procurement and Transplantation Network (OPTN) is operated under contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation by the United Network for Organ Sharing (UNOS). The OPTN brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy.