The Organ Procurement and Transplantation Network’s Kidney Transplantation and Pancreas Transplantation Committees have made key modifications to proposals to replace donation service area (DSA) and region as distribution units in kidney and pancreas allocation policy. These updates reflect major themes identified in public comment and additional committee discussion of potential effects of various policy options. These proposals will be presented to the OPTN Board of Directors at its meeting December 3, 2019.
The key actions as recommended by the committees after public comment include:
- Reduction of the circle size from a radius of 500 nautical miles to 250 nautical miles
- Import backup language removed from kidney and pancreas proposals for additional evaluation
- Medical urgency status removed from the kidney proposal for additional evaluation
Reduction in circle size
Key changes include reduction of the local allocation circle size to a 250 nautical mile radius, as well as reduction of proposed proximity points (a maximum of two points for candidates at transplant programs within the circle and a maximum of four points for candidates listed outside the circle).
Import backup and medical urgency
When they met in October, the committees concluded that additional study and discussion is needed before deciding on the import backup procedure for kidney and pancreas offers, as well as the criteria to determine medical urgency for kidney candidates. As a result, these elements will not be part of the proposals brought for action by the OPTN Board of Directors December 3. The committees will seek additional public comment on these elements, with the intent of including them in implementation alongside the final policies approved by the board.
A workgroup has been formed to address import backup, including members of the Kidney, Pancreas, OPO, Histocompatibility, and Operations and Safety Committees. They will meet weekly for the next month to determine a practical solution to the reallocation of kidneys and pancreata once DSA is removed from allocation. To address kidney candidate medical urgency, a subcommittee of the Kidney committee will also be meeting weekly over the next month to define medical urgency criteria for kidney transplant candidates and determine how this should be operationalized.
The workgroup and subcommittee intend to have criteria ready for supplemental proposals in the Spring 2020 public comment period. Each of the provisions to be presented in supplemental public comment proposals is intended to be incorporated into the kidney and pancreas policies set for approval at the Dec. 3 meeting. The deliberations about these supplemental proposals will include considerations of implementation timing and complexity, with the intent to deliver proposals that can be implemented simultaneously with the removal of DSA and region policies.
Find updates and additional kidney and pancreas resources here.