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OPTN Board approves measures to improve kidney offer acceptance process

Published on: Monday, July 3, 2023

Richmond, Va., - The Board of Directors of the Organ Procurement and Transplantation Network, at its meeting June 26, unanimously approved measures intended to improve the process kidney transplant programs use to consider available organ offers. By making better usage of offer filters, kidney offers may be made more efficiently to programs that are most likely to accept such offers for their candidates.

“Every transplant program is responsible for deciding which characteristics of donor organs are acceptable for their transplant candidates,” said Jerry McCauley, M.D., M.P.H., president of the board. “OPTN offer filters are meant to refine the criteria each kidney transplant program uses. By using this tool in a more sophisticated fashion, we can better ensure that kidney offers are made most efficiently for the patients most likely to benefit from them, thus increasing the number of transplants.”

The OPTN offer filters tool has been available to all U.S. kidney transplant programs since 2022, following earlier pilot testing and ongoing refinement. The tool allows transplant teams to specify certain donor criteria that would cause them not to accept an organ offer, and thus they will not receive organs from those donors. This, in turn, can direct kidney offers more efficiently to programs that will consider them.

In many cases, donor acceptance criteria may come down to a combination of factors. For example, while many transplant programs do not set a maximum age for kidney donors, they might not consider a certain age range alongside another characteristic such as donation upon cardiac death (DCD) status. Offer Filters allow transplant programs to refine their acceptance criteria according to a grouping of donor circumstances (such as a maximum age threshold for DCD donors).

The new approach approved by the OPTN board will create default filters for adult kidney transplant programs, identified as a result of modeling analysis of the program’s organ acceptance patterns. Transplant programs may use these filters, remove them, and/or create their own program-identified filters. A new set of default, model-identified filters will be generated every six months, reflecting the program’s most recent organ acceptance patterns.

Other actions

The board took additional actions as follows:

  • Approved measures that increase the security of the OPTN computer system and OPTN data by placing additional security requirements on OPTN members. In a related action, the board also charged the OPTN Network Operations Oversight Committee to consider additional guidelines or requirements for OPTN members to appropriately manage risk to the OPTN computer system.
  • Accepted additional policy updates to increase access to intended incompatible blood type organ offers for pediatric heart and heart-lung candidates. Some components of this proposed policy are already in place, having been previously approved by the OPTN Executive Committee in March 2023.
  • Endorsed measures to improve evaluation of deceased donors for potentially transmissible diseases endemic to certain areas of the world
  • Approved a set of new data and program requirements to improve efficiency of the OPTN Kidney Paired Donation Pilot Program
  • Endorsed policy changes to expand transplant candidate access to simultaneous liver-kidney allocation
  • Approved revisions to National Liver Review Board guidance to clarify consideration of exception status for candidates needing transplants of multiple abdominal organs
  • Endorsed the appointment of incoming OPTN committee chairs whose term begins July 1, 2023
  • Approved a fiscal year 2024 OPTN budget and registration fee, subject to fee review and approval by the U.S. Department of Health and Human Services
  • Declined, after discussion, to approve a proposed white paper addressing the ethics of transplant candidate listings at multiple hospitals

Discussion items

Board members held focused discussions on the following topics, without taking specific action:

  • Aspects and goals of developing enhanced OPO performance monitoring by the OPTN, including expected outcomes, the standardized processes that could support performance improvement, and the differences between CMS and OPTN monitoring
  • Potential goals, objectives and initiatives to include in the next iteration of the OPTN Strategic Plan