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Redefining Provisional Yes and the Approach to Organ Offer and Acceptance

eye iconAt a glance

Current policy

Current OPTN policy defines provisional yes as when the transplant hospital notifies the OPTN or the host OPO that they have evaluated the offer and are interested in accepting the organ or receiving more information about the organ. Provisional yes is a tool used to manage organ offers; however, in the current system, it is not always effectively used. Because of a high number of offers received by transplant programs, provisional yes is potentially used without an evaluation of every offer. This concept paper discusses a potential solution that includes a three-tiered framework, and associated responsibilities, to standardize organ offer, review, and acceptance practices. Rather than a single provisional yes response with no associated responsibilities, each tier would represent the various stages of communication and responsibilities necessary between OPOs and transplant programs within the organ offer process.

Supporting media

Presentation

View presentation

Proposed concept

  • Develop a tiered framework that will standardize organ offer, review and acceptance practices, and outline member responsibilities
  • Recommend time limit on offers and number of offers that can be sent within tiers
  • Increase efficiency and expedite organ placement
  • Gather community feedback on framework

Anticipated impact

  • What it's expected to do
    • Redefine “provisional yes”
    • Limit the amount of organ offers sent out to manage offer burden
    • Determine the appropriate time limits for organ offers
    • Reduce overall organ allocation time
    • Gather community feedback
  • What it won't do
    • This concept paper is intended to provide an update and solicit feedback; it will not result in a change in policy without additional public comment

Terms to know

  • Provisional yes: When the transplant hospital notifies the OPTN or the host OPO that they have evaluated the offer and are interested in accepting the organ or receiving more information about the organ.
  • Organ offer acceptance: When the transplant hospital notifies the host OPO that it accepts the organ offer for an intended recipient, pending review of organ anatomy. For kidney, acceptance is also pending final crossmatch.
  • Organ offer refusal: When the transplant hospital notifies the OPTN or the host OPO that they are declining the organ offer.
  • Organ procurement organization (OPO): An organization authorized by the Centers for Medicare and Medicaid Services, under Section 1138(b) of the Social Security Act, to procure organs for transplantation.
  • Primary potential transplant recipient: The first candidate according to match run sequence for whom an organ has been accepted.
  • Backup Offer: An organ offer made to a lower ranked candidate on a deceased donor match run after a transplant hospital accepts an organ on behalf of a higher ranked candidate, but before the organ is transplanted.
  • Transplant program: A component within a transplant hospital that provides transplantation of a particular type of organ.

Click here to search the OPTN glossary

Provide feedback

eye iconComments

LifeGift | 08/11/2022

Thank you for the good effort here to address the serious abuse of the provisional yes original goal. While the effort is laudable, when thinking about this set of tiered responses in isolation (for a single offer), it seems practical and useful, However, when thinking about this in the context of a huge outflow and inflow of offers per OPO and a center, it seems overwhelmingly complex and may have unintended consequences of increasing complexity. Suggest starting first with addressing capacity issues by employing offer filters and addressing the problem at its core before moving to adding 3 levels of offer types. Thank you

Harvey Solomon | 08/11/2022

I suggest that in Tier 3 there is an affirmation from the implanting surgeon or their approved representative that the donor quality, data have been discussed and agreed upon. This will hopefully limit miscommunication and discard of organs. Any occurrence will be recorded and result in corrective action plan.

Anonymous | 08/10/2022

The proposed system seems complex as outlined in presentation. I worry about increased physician and coordinator burnout as organ offers require substantial scrutiny in Phase II or Phase I offer when in reality you would rarely scrutinize an organ unless you were in a favorable sequence number to preserve sleep and sanity. It seems like it will increase provider work and time awake, which is not sustainable for this profession.

Anonymous | 08/09/2022

I don't think this proposal deals with the root causes of organ placement inefficiency. 1. OPO's send too many offers at once because they fear the provisional yes has not really been well screened 2. Transplant centers are not really screening offers at the time they receive them. 3. The exponential increase in mandatory multivisceral placements has led to the inability to allocate more than one organ at a time. I must place the heart before placing the lungs. I must place the lungs before placing the liver. Each of these things adds considerable time to the process. The tier 3 option already exists, centers can already decline for their entire center and/ or begin selectively declining for individual candidates. I don't see how adding more levels of provisional yes adds efficiency. Additionally it is likely that centers will want more time to consider offers already received as we progress from Tier 3 to 2 to 1. This also does not address the practice of centers declining when the sun comes up, based on information that was available when the offer was received 6 hours prior I would certainly support limiting the number of centers to which an OPO can offer an organ (e.g. not being able to offer if more than "x" centers with provisional yes), but this proposal as it stands does little to address the underlying issues

Rebecca Baranoff | 08/07/2022

I agree with the concept of the 3-tiered framework to remove the provisional yes and provide a more structured format for accepting or denying organs. I do think the suggested time limit on offers is too short; I suggest 2 hours as the length of time.

Kidney Donor Conversations | 08/04/2022

Support changes to increase efficiencies and decrease the time for organ transplants.