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OPTN Board approves VCA transplant programs, liver allocation refinements, and strategic plan

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UNOS News Bureau

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The Board of Directors of the Organ Procurement and Transplantation Network, at a virtual meeting held June 14, approved 40 vascularized composite allograft (VCA) transplant programs across eight specialty categories. VCA transplants involve complex structures that may include organs, bone, muscle, skin, nerves, blood vessels and/or connective tissue.

“The fact that we now have these specialty programs is a reflection of how rapidly VCA transplantation has evolved in just the last few years,” said David Mulligan, M.D., president of the board. “We believe this will allow these programs to provide high quality of care and continue to advance successful treatment for VCA recipients.”

Each approved program has met previously approved OPTN minimum requirements, including specific training and experience of key personnel. The new, specialized VCA transplant program categories are:

  • Upper limb
  • Head (craniofacial allograft) and neck
  • Abdominal wall
  • Genitourinary organs
  • Glands
  • Lower limb
  • Musculoskeletal composite graft segment
  • Spleen

The searchable Member Directory on the OPTN website now lists approved transplant programs for each of the VCA specialties.

In a separate action, the Board voted to modify the OPTN living donor policy to incorporate requirements for living donor VCA transplants. This action will allow living donor VCA transplantation to be consistent with the overall requirements of OPTN living donor policy, with some specific provisions for VCA living donor procedures. Of the 32 uterine transplants performed in the United States between September 2016 and May 2021, 20 have involved living donors.

Liver allocation updates

The Board accepted modifications to the liver allocation policy concerning the calculation of median MELD at transplant (MMaT) scores for candidates who have exception scores. The MMaT calculation will now be based on transplants performed within a 150 nautical mile circle around the donor hospital; the MMaT is currently based on transplants performed within 250 nautical miles of the candidate’s transplant hospital.

The modifications will also change the order of sorting liver transplant candidates on organ match runs.  Pediatric candidates will appear on the match run before adult candidates when they have the same MELD or PELD score and the same compatibility with the donor’s blood type. In addition, transplant candidates without a MELD or PELD exception will appear on the match run before exception candidates when they have the same MELD or PELD score and the same compatibility with the donor’s blood type, and when they are in the same age category (pediatric or adult).

Strategic plan

The board approved a new OPTN Strategic Plan for 2021 through 2024. While the overall goals are similar to those in previous plans, the supporting objectives, tasks and priorities have been extensively restructured with input from the transplant community and public. A previous strategic goal of increasing efficiency of the OPTN has now been incorporated into the broader goal of increasing transplants. The new plan contains four strategic goals:

  • Increase the number of transplants
  • Provide equity in access to transplants
  • Improve waitlisted patient, living donor, and transplant recipient outcomes
  • Promote living donor and transplant recipient safety

Other actions

The board took additional actions as follows:

  • Approved clarifications to policies that address allocation of multiple organs (Sponsor: Organ Procurement Organization Committee)
  • Accepted updates to guidance used by the National Liver Review Board (NLRB) and a policy clarification regarding exceptions for candidates with cholangiocarcinoma (Sponsor: Liver and Intestinal Organ Transplantation Committee)
  • Endorsed updates to organ offer refusal codes (Sponsor: Data Advisory Committee)
  • Approved modifications to the Deceased Donor Registration form Sponsor: Organ Procurement Organization Committee)
  • Accepted requirements for member notification in cases where HLA typing of donors or transplant candidates has changed (Sponsor: Histocompatibility Committee)
  • Approved clarifications to policies and bylaws regarding VCA transplantation (Sponsor: Vascularized Composite Allograft Transplantation Committee)
  • Endorsed revisions to an OPTN Ethics Committee white paper addressing General Considerations in Assessment for Transplant Candidacy (Sponsor: Ethics Committee)

Discussion items

The Board was briefed on the OPTN Executive Committee’s resolution to sunset an emergency action related to listing non-dialysis kidney transplant candidates during the COVID-19 pandemic. The Board hosted additional discussion on the following initiatives:

  • An update and early data analysis relating to the revised kidney and pancreas allocation system implemented in March 2021
  • A presentation from the OPTN Network Operations Oversight Committee (NOOC), assessing a number of metrics regarding the organ matching system and implementation of Board-approved projects and describing upcoming IT system enhancements
  • A project in development by the OPTN Membership and Professional Standards Committee to improve metrics used in monitoring of transplant programs
  • Data analysis of the 12-month period since implementation of the acuity circles system for liver and intestinal organ transplantation
  • A feasibility study and potential data sources to analyze how social determinants of health may affect organ transplantation
  • Progress to date on a study of the OPTN regional structure, an initiative called for in the current OPTN contract
  • Progress to date on seeking nominees for open Board and committee positions for 2022
  • Updates on projects under review by the OPTN Policy Oversight Committee
  • An update from the OPTN Finance Committee on the status of the current fiscal year budget