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Journal article describes UNOS research in transplant priority for prior living kidney donors

Four UNOS researchers examined delays in timely access to transplantation for some prior living donors who later require a transplant themselves. Their study is published online in the Clinical Journal of the American Society of Nephrology.

Prior living donors who later need a deceased donor kidney transplant receive very high allocation priority. To be listed for this priority, transplant programs must submit a request to UNOS. Any delay in a program’s submission may delay timely access to transplantation. The authors (Jennifer Wainright, Ph.D., David Klassen, M.D., Anna Kucheryavaya, M.S., and Darren Stewart, M.S.) studied OPTN and CMS data to examine the timing of priority requests for 210 prior living donors who were added to the kidney waiting list over a five-year period.

While most prior living donors received priority and were actively listed for a transplant in a timely manner, a substantial number spent considerable time either actively listed for a transplant without living donor priority or listed in an inactive status. This, in turn, affects their access to timely transplantation. UNOS has implemented processes to help programs prevent future delays in requesting living donor priority.

To view the entire article, consult the following citation:

J. Wainright, D. Klassen, A. Kucheryavaya, and D. Stewart. Delays in Prior Living Kidney Donors Receiving Priority on the Transplant Waiting List. Clinical Journal of the American Society of Nephrology. Available online at http://cjasn.asnjournals.org.

Join us for upcoming ethics webinar

The next webinar in the UNOS ethics series is coming soon. Learn more about this session and view the full schedule below.

Ethical complexities and living donation – 1

September 28, 2016 at 2 p.m. ET
Cost: $25

Featured Experts: Peter Reese, MDElisa Gordon, PhD, MPH; Laurie Shore, MSW, LCSW; and Mary Amanda Dew, PhD
When finding a living donor, there are many important ethical considerations: pressure and coercion, social media campaigns, maintaining confidentiality, donor rights, informed consent and medical and psychosocial evaluation. What about the risks of being a liver donor, including death? And what are the hospital’s responsibilities when living donors have complications?

Register now

To register for this webinar, go to UNOS Connect, our learning management system.

  • If you have access to UNOS Secure EnterpriseSM systems: UNet, WaitlistSM, DonorNet®, Tiedi®, KPDSM and other UNOS-developed transplant applications, your UNOS Connect account is already set-up. Simply access UNOS Connect with your UNet username and password. This will allow you full access to the site to view system training recordings, register for policy webinars and view materials.
  • Other Users: The first time you visit UNOS Connect, you will need to complete a brief, online form to register for the site. After that, you will have access to a wide range of UNOS instructional offerings and materials, except system training.

About the UNOS ethics webinar series

In an educational assessment earlier this year, we asked what topics you wanted to learn more about. The most requested was education on ethical issues. That’s why UNOS is offering a new webinar series that focuses on ethics and provides you with continuing education.

This continuing nursing education activity was approved by the Virginia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. In addition, this program is approved by the National Association of Social Workers (Approval # 886443310-0) for 1 Social Work continuing education contact hour.

Upcoming webinars

Ethical complexities and living donation – 2

October 31, 2016 at 1 p.m. ET
Cost: $25

Featured Experts: Lainie Ross, MD, PhD.; Laurie Shore, MSW, LCSW; and Mary Amanda Dew, PhD
How can we remove the disincentives to living donation? What if the living donor ends up needing a kidney? Should uninsured people be considered for living donation? What constitutes valuable consideration? And what about non-directed donation, orphaned donors, and paired donations and chains?

Increased risk donation

January 2017
Cost: $25

Featured Experts: Art Caplan, PhDLainie Ross, MD, PhD; and Bob Veatch, PhD
Certain illnesses and behaviors put donors into the PHS increased risk category. Learn more about donors with hepatitis, HIV (and the HOPE Act) and cancer as well as those with high-risk histories, such as IV drug use, prison and even multiple transfusions. What about donors with other diseases such as Alzheimer’s? How about patients with Lou Gehrig’s? How much should candidates be told about their donor’s history? Does that change when they have a living donor? Listing practices will also be covered.

Ethics of allocation

February 2017
Cost: $25

Featured Experts: Michael Shapiro, MDPeter Reese, MD; and Bob Veatch, PhD
Hear about the general moral theory behind allocation as well as voluntary risks (alcoholism, non-compliance, etc.), age, status and obesity. Learn about geographical disparities and the tension between local versus national allocation. How do listing practices and exceptions play a role? We’ll cover multiple listing, level of pay, competition for organs, multi-organ allocation, and multiple transplants for the same patient.

Selection and acceptance criteria

March 2017
Cost: $25

Featured Experts: Art Caplan, PhD
How are patients selected to be listed for a transplant? And how do transplant teams decide which organs to accept for their patients? What role do addiction, age, obesity and compliance with treatment play? Should transplant outcomes in listing drive treatment? What about waitlist modification? And how about centers who say they accept anything, but don’t in practice?

Socio-economic matters

April 2017
Cost: $25

Featured Expert: Janet Stevenson
What happens when someone wants to direct a donation based on race, gender, socio-economic status or membership in a group? Given the cost of transplantation, are transplants really elective? What happens when folks can no longer pay or lose their insurance? What inequities are there for poor people who need transplants, in multiple listing, people who live in rural areas? Learn about valuable consideration in both living and deceased donation as well as poor people who sell their organs in other countries. What are the barriers to donation and transplant for minorities?

Technological advances and ethical conundrums

May 2017
Cost: $25

Featured Expert: Janet Stevenson
What are the ethical considerations in vascular composite allograft (VCA) transplantation, like face and hand transplant? How about the newest elective VCA transplants – uterine and penile transplants? What about the human trial element? What are the special informed consent requirements? How do you weigh the risk of unnecessary exposure to immunosuppression against the benefits? What are the inclusion/exculsion criteria? We’ll also cover other technological advances such as growing organs, cloning to produce human organs, stem cell scaffolds, animal/human hybrids to produce organs and destroying and replacing bone marrow.

Archived webinars

Go to UNOS Connect to view recordings of earlier webinars in the series.

An overview of ethics in transplantation

June 30, 2016 
Cost: Free

Featured Experts: Art Caplan, PhDMichael Shapiro, MD
Learn about religious and secular views on transplantation, how we got to our current system, and the concepts of autonomy, justice, non-maleficence, beneficence. Use what you’ve learned to decide what you would do during the case study portion of this session.

The ethics of death

August 11, 2016 
Cost: $25

Featured Experts: Michael Shapiro, MDBob Veatch, PhD
How is death defined, and why is that so important and even troublesome? What are the cultural implications about how treat patients who are alive versus those who are dead? How does care/treatment and insurance coverage change? What about making the choice to die? What ethical concepts are involved when a terminal patient wants to die? And what is imminent death donation?

Ethical procurement

August 25, 2016 at 2 p.m. ET
Cost: $25

Featured Experts: Michael Shapiro, MDBob Veatch, PhD
Dig into the meaty topics of directed donation and social media to find donors. Explore international topics such as presumed consent and transplant tourism, the use of prisoners as organ sources and how international transplant tourism impacts patients in the U.S.

18-month analysis shows progress in kidney allocation system

An analysis of data 18 to 20 months after implementation of the kidney allocation system (KAS) shows a number of longer-term patterns, with success in a number of key system goals. The detailed report can be found here.

Trends include the following:

  • The volume of deceased donor kidney transplants performed per month increased by 6.9 percent from the year prior to KAS implementation to the 18 months afterward. This appears to be due to a substantial increase in deceased donation beginning in 2014 and continuing into 2016.
  • Significant “bolus effects” have occurred for candidates who received additional transplant priority under KAS, including those with very high immune sensitivity and those with lengthy dialysis times prior to transplant listing. Because the previous policy didn’t provide them as much priority, many of these candidates who had been waiting for years received a transplant soon after the new policy was implemented. The number of transplants per month for these candidates has declined as fewer are now listed for a transplant with high priority, but they are still being transplanted at rates higher than they were prior to KAS.
  • The percentage of transplant recipients experiencing delayed graft function (DGF) increased initially post-KAS but has since declined slightly. This finding may be influenced by the bolus effect for recipients who have been on dialysis longer-term.
  • The kidney discard rate after KAS has remained higher than the period before KAS implementation – from 18.5 percent pre-KAS to 19.8 percent at 18 months post-KAS. The increase was most noticeable for kidneys with a Kidney Donor Profile Index (KDPI) between 86 and 100 percent.
  • Transplants for pediatric patients (age 0-17) have declined slightly, although pediatric patients continue to receive priority that provides them much greater access to timely transplants than older candidates. Pediatric recipients are also more often receiving kidneys expected to last longer (lower KDPI) under KAS.
  • The six-month kidney graft survival rate (organ function post-transplant) decreased slightly but continues to exceed 95 percent. Similarly, the six-month patient survival rate has decreased slightly but remains above 97 percent.

The OPTN/UNOS Kidney Transplantation Committee will continue to analyze these trends carefully, as well as other data that will be available longer-term.

These recent findings are based on limited data. They must be interpreted cautiously and further tracked to assess whether observed trends will be sustained.

For additional reference, consult the article in the June 2016 edition of American Journal of Transplantation:
Stewart DE, Kucheryavaya AY, Klassen DK, Turgeon NA, Formica RN, Aeder MI. Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation. American Journal of Transplantation, 16(6), 1834-1847.

Share your feedback about policy proposals out for public comment

You have a voice in shaping US organ transplant policy

 

The Organ Procurement and Transplantation Network (OPTN) is offering fifteen proposals for public comment on August 15 – October 15. Proposals include:

View all proposals now

Join the conversation

In order to promote transparency and trust in the national transplant system, comments and replies will be published on the OPTN website. A commenting tool on the website, called DisQus, will allow visitors the option to share comments on social media as well.

The deadline for feedback is October 15, 2016. The committees sponsoring the proposals review and consider every comment before developing final proposals for a vote by the OPTN/UNOS Board of Directors.

Transplant patient webinar explains proposed changes to liver distribution, opportunity for public comment

UNOS, in its role as the national Organ Procurement and Transplantation Network (OPTN), is proposing changes to the geographic distribution system for liver transplantation. We will seek public comment on the proposal from August 15 through October 15.

The proposed changes will be explained during a live, one-hour webinar for transplant candidates, recipients and donor families on August 22, 2016 at 6 p.m. Eastern time.

Register for the webinar

Phone number: 1-888-936-7423
Access code: 505-863-977
Audio PIN: Shown after joining the webinar

The proposed policy is meant to ensure that patients across the country waiting for a liver transplant would have a more equal chance of getting a transplant before they become very sick. Under the current distribution system, the number of transplant candidates per available donor varies widely from one area to another. Proposed changes would increase equity by establishing eight liver distribution districts nationwide that were designed to balance organ availability with the number of liver candidates.

why liver transplant policy needs to change

We welcome comments and questions about the proposal from everyone who has an interest in liver transplantation. If you have personal experience with transplantation or donation, your feedback is vital to ensure that the transplant process reflects your needs and perspectives. Beginning August 15, you’ll find the public comment proposal on the OPTN website under Governance > Public Comment.

Webinar to address revised heart policy proposal

During the August – October 2016, public comment cycle, the OPTN/UNOS Thoracic Organ Transplantation Committee  is issuing a revised proposal to improve the adult heart allocation system. The Committee is offering a webinar on August 18, 2016 to explain the proposed changes so that members can later comment on the proposal. Beginning August 15, you’ll find the public comment proposal on the OPTN website under Governance>Public Comment. 

Date: August 18, 2016

Time: 10 a.m. to 11:30 a.m. Eastern

Registration Information:
https://attendee.gotowebinar.com/register/4234231749395979265

Participants can use their computer’s microphone and speakers (VoIP) or telephone.
United States (Toll-free): 1 866 952 8437
United States: +1 (914) 614-3429
Access Code: 653-139-972
Audio PIN: Shown after joining the webinar

Purpose of the webinar
This webinar is designed to explain the proposed changes, the problems that the proposal will solve, the goals of the proposal and alternatives the committee considered. The webinar will also detail revisions made in response to issues raised regarding the document originally published for public comment in January 2016, including the following:

  • Stricter qualifying criteria and extension criteria for some of the more urgent status categories
  • Limiting the proposed broader geographic sharing scheme for the most urgent candidates to donation service area and Zone A (instead of through Zone B)
  • Modification of the pediatric donor allocation sequence to mitigate the impact to pediatric candidates of changes to adult heart allocation policy
  • Clarification of the types of mechanical circulatory support devices that qualify for each status
  • Requiring regional review boards to review cases external to their region
  • Detailed listing of additional data the committee proposes to collect for future development of a heart allocation score

After participating in this webinar, attendees will understand the potential impact the proposed changes would have on their transplant centers if it passes.

Webinar Presenter:
Joseph G. Rogers, M.D., immediate past chair of the OPTN/UNOS Thoracic Organ Transplantation Committee