November 13, 2012
OPTN/UNOS Board addresses living donation policies, kidney paired donation requirements, lung allocation, geographic differences in organ allocation
St. Louis – The OPTN/UNOS Board of Directors, at its meeting November 12 and 13, approved policies to create greater consistency in the medical and psychosocial evaluation and informed consent processes for living kidney donors and increase the level of clinical information reported on post-transplant outcomes for these donors.
"Some individual transplant programs already meet the requirements we have established,” said OPTN/UNOS President John Roberts, M.D. "Our goal is to ensure that all programs meet these standards."
The policies specify a minimum set of required tests and procedures for the medical and psychosocial evaluation of potential living kidney donors, as well as a minimum set of requirements for informed consent for the donation procedure including the role of an independent donor advocate. Transplant programs, at their discretion, may conduct additional tests or have additional requirements for informed consent. The development of similar policies for living liver donors is currently under discussion.
The Board also approved a policy to enhance reporting of timely followup data on living kidney donor outcomes up to two years after the donation. Each transplant program will need to report complete and timely donor status and clinical information for at least 80 percent of living kidney donors who donate after December 31, 2014. Programs must also report common laboratory test results of kidney function for at least 70 percent of living kidney donors who donate after December 31, 2014.
Lower, intermediate thresholds for reporting living kidney donor outcome data will apply to living kidney donors who donate after February 1, 2013. In the interim, educational and resource material will be provided to programs to help them develop protocols to enhance collection and reporting of donor followup data.
In other action, the OPTN/UNOS Board adopted a series of policies applying to transplant centers who participate in the OPTN's national program to facilitate kidney paired donation (KPD). The Board also approved the matching of "bridge" donors in KPD chains. A "bridge" donor would be a potential living donor who is not immediately matched with a recipient after a series of KPD transplants. The policy would allow this donor, with his or her consent, to be matched at a later time with a new chain of KPD transplants. The use of “bridge” donors is expected to increase the number of potential donor-recipient matches and transplants that can be performed.
The Board also approved changes to calculation of the lung allocation score (LAS), which is the primary factor in prioritizing organ offers for lung transplant candidates. The updated LAS is expected to balance priority for all groups of candidates and particularly provide more accurate assessment of the medical needs of candidates with pulmonary artery hypertension.
In addition, the Board also charged the OPTN/UNOS organ-specific allocation committees to identify and incorporate organ-specific measures to reduce existing differences in allocation of organs for transplantation among different geographic areas of the country.
As soon as it is available, an executive summary of all Board meeting actions will be posted to the OPTN Web site. The site also contains summaries of proceedings from past OPTN/UNOS Board meetings.
The Organ Procurement and Transplantation Network (OPTN) is operated under contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation by the United Network for Organ Sharing (UNOS). The OPTN brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy.