Kidney and pancreas allocation changes postponed
Published on: Monday, December 14, 2020
Amendments to kidney and pancreas allocation policies that were approved by the Organ Procurement and Transplantation Network Board of Directors in December 2019, and were originally intended for implementation Dec. 15, 2020, will be held in abeyance until Feb. 13, 2021. The Health Resources and Services Administration directed the OPTN to delay implementation of these amendments to allow the U.S. Department of Health and Human Services to review a critical comment recently submitted regarding kidney allocation policy.
This action means that the current policies that allocate kidneys and pancreata will remain in effect pending further notice. In all instances, organ procurement organizations and kidney and pancreas transplant programs should continue to follow the match run generated in UNetSM for donors and potential recipients of these organs.
We will continue to update you on additional developments.
What you need to know
Current OPTN Policy 8: Allocation of Kidneys and OPTN Policy 11: Allocation of Pancreas, Kidney-Pancreas and Islets will remain in effect until Feb. 13, 2021. Deceased donor organs will continue to be allocated to patients on the waiting list and there will be no disruption of organ recovery or transplantation.
The postponed implementation means that allocation of released kidneys and pancreata must continue as currently outlined in Policy 5.9: Released Organs:
- The transplant surgeon or physician responsible for the care of a candidate will make the final decision whether to transplant the organ. The transplant program must transplant all accepted, deceased donor organs into the original intended recipient or release the deceased donor organs back to and notify the host OPO or the OPTN for further distribution. If a transplant program released an organ, it must explain to the OPTN the reason for refusing the organ for that candidate. The host OPO must then allocate the organ to other candidates according to the organ-specific policies. The host OPO may delegate this responsibility to the OPTN or to the OPO serving the candidate transplant program’s DSA. If extra vessels are not used for the recipient, then the transplant hospital may use, share, or store extra vessels, according to Policy 16: Organ and Extra Vessels Packaging, Labeling, Shipping, and Storage.
Medically urgent kidney candidates
The current Policy 8.2.a: Exceptions Due to Medical Urgency will continue to be in effect and there will be no changes to how transplant hospitals and OPOs classify medically urgent kidney candidates. Determining medically urgent status for kidney candidates must continue as outlined in Policy 8.2.a. Exceptions Due to Medical Urgency:
- Prior to receiving an organ offer from a deceased donor in the same DSA, a candidate’s transplant physician may use medical judgment to transplant a candidate out of sequence due to medical urgency. If there is more than one kidney transplant program in the DSA, then the candidate’s physician must receive agreement from the other kidney transplant programs in the DSA to allocate the kidney out of sequence and must maintain documentation of this agreement in the candidate’s medical record.
On Dec. 1, 2020, Phase I implementation of the now-postponed policy Addressing Medically Urgent Candidates in the New Kidney System went into effect. During that transition period, programs were able to update candidate data and upload supporting documentation into the WaitlistSM patient record ahead of the planned Dec. 15 implementation of circle-based allocation. As a result of the postponement, any medically urgent status requested for candidates during Phase I will not apply; a candidate’s current status will be continue to result from agreements based upon Policy 8.2.a.
Professional education offerings regarding features of the new system will be temporarily removed. They will be updated and restored as developments warrant.
Questions?
If you have questions about data or information systems, contact UNOS Customer Service at 800-978-4334. For policy-related questions, send an e-mail to member.questions@unos.org.