Comments

Keith Plummer | 02/20/2025

I agree with all points addressed in this proposal and fully support.

OPTN Kidney Transplantation Committee | 02/20/2025

The OPTN Kidney Transplantation Committee (Committee) appreciates the opportunity to comment on this Request for Feedback. The Committee supports changes to multi-organ allocation policies that promote access to transplant for kidney-alone candidates, particularly pediatric kidney candidates and highly sensitized kidney candidates, and for multivisceral candidates, who are typically pediatric candidates. The Committee supports a standardized policy to promote access to transplant for these populations. The Committee is concerned that under current policy, kidneys are typically allocated to kidney multi-organ candidates prior to being offered to kidney-alone candidates, and that multivisceral candidates do not receive offers very often. The Committee recommends that the Ad Hoc Multi-Organ Transplantation Committee consider how virtual crossmatching can be employed to support implementation of the policy proposal under development, since organ procurement organizations are often asked to send blood samples for crossmatch for multi-organ candidates. There is a finite amount of blood that can be sent for sampling from each donor and the time to transport samples and perform physical crossmatches can potentially delay operating room times and/or run up against donor family timing constraints.

Rajdeep Das | 02/14/2025

The proposed multi-organ allocation policy seeks to establish a standardized framework for organ distribution, ensuring fairness and efficiency in the allocation process. It aims to address key challenges such as ambiguous priority rankings, regional disparities in organ procurement, and resource-intensive allocation procedures. It is a significant step forward and by implementing this policy, the organ distribution system can potentially move toward greater equity and operational effectiveness. However, some potential challenges that need to be addressed are: (1) Implementation Complexity: The proposed system requires significant changes to the OPTN Computer System, risking delays and temporary inefficiencies. Potential solution could be: A phased rollout with training for OPOs and transplant programs can ease the transition; (2) Lack of a Unified Match Run: The proposal does not introduce a single match run, which could streamline allocation. Potential solution could be: Future revisions should explore integrating all organs into a standardized match system; (3) Limited Donor Group Inclusion: High KDPI donors and rare organ combinations are not comprehensively addressed. Potential solution could be: Further data analysis should determine if additional allocation tables are needed; (4) Incomplete CPRA Consideration: CPRA’s impact beyond kidney allocation and on pediatric candidates is unclear. Potential solution could be: Expanded CPRA prioritization and adjusted weighting for pediatric patients can ensure fairness and (5) Risk of Organ Non-Utilization: Prioritizing highly sensitized candidates may increase discard rates. Potential solution could be: A contingency plan should allow flexibility when no suitable match is found.

Oyedolamu Olaitan | 02/02/2025

This is a very important and difficult work, kudos to the Ad HOC MOT committee for the hard work. I support the proposals, but would like to add that for the "DBD donors aged 11-17, KDPI 0-34%", if Kidney Classification 6 (pediatric within 250NM) is going to be placed above Pancreas Classification 4 (P or KP within 250NM); it is important to make a provision in the policy to make a kidney available for the simultaneous pancreas kidney (SPK) recipient in cases where there is no pancreas alone recipient so as to avoid non-utilization of good pancreas. Currently pancreas has high non-utilization rate, which is multifactorial in origin and the Pancreas Committee is working to reduce these, however, the proposal as written is likely to worsen that as most pancreas recipients are SPK, within Classification 4 and mostly utilize pancreas from donors within 250NM. Thanks you for the opportunity to comment.