Read the full concept paper (PDF – 338 K; 1/2018)

Expedited organ placement has been an important part of organ allocation for many years. Organ procurement organizations (OPOs) utilize this method to quickly place organs that are at risk of discard. OPTN/UNOS policy does not currently address expedited placement except for Policy 11.6: Facilitated Pancreas Allocation. Consequently, during recent discussions about broader sharing and system optimization, the community has expressed a want to better understand expedited placement, understand its impact on transplant candidates, and to maximize utilization of transplantable organs. The OPO Committee (“the Committee”) is seeking feedback from the donation and transplant community. The Committee intends to use this feedback in the development of policy language intended to address the following problems:

1. Lack of transparency with the current system
2. Lack of guidance for OPOs and transplant hospitals
3. Lack of consistent practice across the country
4. Inconsistent access to organs for candidates in need of transplant

Due to the complexity of this issue, the Committee made the decision to focus on the liver allocation process during the initial phase of this project. The intent is to develop a framework for expedited placement, initially focusing on liver placement, that can eventually be applied to the other organ systems.

The Committee determined that any expedited placement system is likely to have three components:

1. A trigger – the determination to perform expedited placement
2. A mechanism – the way expedited placement gets initiated in the match system
3. A qualification – the determination of how transplant hospitals qualify to receive expedited offers on behalf of their patients

The Committee determined that separate triggers are needed to address the different scenarios that might lead OPOs to initiate expedited placement:

1. Prior to donor recovery procedure (pre-operating room)
2. In the operating room

The Committee is aware that certain transplant hospitals are more likely to accept expedited placement offers than others. Therefore, the Committee would like to outline how transplant hospitals qualify to accept expedited offers.

The Committee seeks public comment regarding the triggers for expedited placement as well as determining which transplant hospitals might qualify for such offers. The Committee is concerned that proposing a system that is too cumbersome will have a negative impact on the expedited placement process and could result in a loss of organs for transplant. The Committee plans to circulate a policy proposal during the fall 2018 public comment cycle.

Specific Questions

The Committee is requesting feedback on the following questions:

1. Should an allocation system include an expedited placement trigger based on defined donor characteristics that would allow an OPO to expedite the placement of an organ?
2. Should an allocation system include an expedited placement trigger based on an event like an organ declined in the OR that would allow an OPO to expedite the placement of an organ?
3. Should the allocation system allow an OPO to move to an expedited list after a well-defined point in the allocation process (e.g., after offers to x candidates, after offers to x hospitals, within x hours of the scheduled OR time)?
4. Once an expedited placement trigger has been met, should the OPO use their own discretion to get the organ placed for transplantation?
5. Once the expedited placement trigger has been met, should the list of potential candidates be limited to those at transplant hospitals with a recent history of transplanting organs from similar donors?
6. Should transplant hospitals be allowed to choose whether or not they want to have their candidates on an expedited list?
7. Should the allocation system give higher priority to candidates more likely to accept an organ that has a higher likelihood of discard based on statistical models?
8. Should DonorNet^® set a transplant hospital’s acceptance criteria based on the hospital’s past acceptance practices?