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U.S. organ transplants, deceased donors set record in 2016

New record set: 33,608 organ transplants in 2016

Organ transplants performed in the United States in 2016 reached a new record high for the fourth consecutive year, according to preliminary data from United Network for Organ Sharing (UNOS). UNOS serves as the national Organ Procurement and Transplantation Network (OPTN) under federal contract. For the year, 33,606 transplants were reported, representing an 8.5 percent increase over the 2015 total and an increase of 19.8 percent since 2012.

“Thousands more men, women and children are receiving a life-saving transplant opportunity each year,” said Stuart Sweet, M.D., Ph.D., President of the OPTN/UNOS Board of Directors. “We are deeply grateful to all who have chosen to help others through the life-saving act of organ donation. We are also very conscious that many more people are still anxiously awaiting a transplant, so we must continue to work with our partners in the donation and transplant community to meet the needs of those who continue to wait.”

The growth in overall transplants was largely driven by an increase of 9.2 percent in the number of deceased donors from 2015 to 2016, continuing a six-year trend of annual increases. Many deceased donors provide multiple organs for transplantation. Approximately 82 percent (27,628) of the transplants involved organs from deceased donors. The remaining 18 percent (5,978) were performed with organs from living donors.

US transplants increased 20% over last five years  

“This increase in organ transplants is partly a realization of an ongoing commitment to improvement at organ procurement organizations, transplant hospitals, and UNOS,” said Brian Shepard, UNOS’ Chief Executive Officer. “Organ transplantation has long been at the forefront of data-driven quality improvement, and OPOs and UNOS are working together on a technology-driven transformation in the way organ donors are identified and recovered.” (See UNOS’ recent public service announcement to promote transplant awareness.)

In addition, an increasing number of deceased donors in 2016 had medical characteristics or a medical history that, in prior years, may have been considered less often by clinicians. These include people who donated after circulatory death as opposed to brain death, as well as donors who died of drug intoxication or those identified as having some increased risk for bloodborne disease.

“While donation and transplant professionals always use their best medical judgment in evaluating donors and organ offers, over the last several years we’ve had success using organs from donors with certain criteria we may not have accepted in the past,” said David Klassen, M.D., UNOS’ Chief Medical Officer. “Among our key goals as the OPTN, working with our members nationwide, is to ensure that as many organs as possible are accepted and used for the patients who will benefit from them the most, while maintaining high levels of patient safety.” (See OPO leaders describe effective practices to increase the number of organs donated.)

United Network for Organ Sharing (UNOS) serves as the Organ Procurement and Transplantation Network (OPTN) by contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.

Phase I of COIIN pilot begins in January

Phase I of the pilot stage of COIIN (Collaborative Innovation and Improvement Network) will begin in January 2017. Visit the COIIN resource page for background information and resources and a current timeline of the project plan.

Nineteen transplant hospitals were selected to participate in the initial pilot phase of the project. COIIN program staff and advisors have completed onsite coaching visits to each of the hospitals to review with them the pilot process, demonstrate the data collection and collaborative learning tools to be used, and prepare them for the Phase I kickoff. Pilot participants will each send representatives to participate in a Phase I kickoff meeting Jan. 10-11 in Richmond, Va.

Phase I of the pilot will involve three action periods for innovation and learning, each focused on a specific topic area: organ offers and acceptance, waitlist management, and care coordination. During each action period, pilot participants will develop and implement a series of 90-day action plans using the PDSA (Plan/Do/Study/Act) methodology. They will track their progress and share information on a collaborative learning website. They will also participate in a virtual learning session to be held in April 2017.

A learning congress will be held near the conclusion of Phase I. The learning congress will focus on key insights and refinements of materials such as the intervention guides. COIIN staff and advisors will incorporate learning and knowledge from Phase I and facilitate discussion with Phase II invitees.

Applications will open in spring 2017 for hospitals wishing to be considered for the second pilot phase of COIIN that will begin in October 2017. Selections for this phase will be made from a combined pool of new applicants and applicants not selected for the first pilot phase. Hospitals who previously applied for consideration will not need to fully re-apply, although updated information may be necessary.

Additional information and updates will be posted soon. For more information, contact Nicole Benjamin, UNOS’ Program Manager for COIIN, by phone at 804-782-4622 or via email at nicole.benjamin@unos.org.

UNOS researchers examine rise in kidney discard rate

Five UNOS researchers (Darren Stewart, M.S.; Victoria Garcia, M.P.H.; John Rosendale, M.S.; David Klassen, M.D.; and Bob Carrico, Ph.D.) recently analyzed factors underlying the steady increase in discards of deceased donor kidneys recovered for transplantation, most notably in the last decade. Their study is available in the “Early View” (pre-print) online feature of the journal Transplantation.

View the study

The kidney discard rate more than tripled from the late 1980s to 2009, from approximately five percent to nearly 20 percent. The study found that at least 80 percent of the increase in the discard rate can be explained by the expansion of kidney donor criteria and clinical practice changes in biopsies and pump preservation of recovered kidneys. However, these factors did not account for some residual change. The researchers conclude that behavioral factors, such as concern over use of kidneys with greater donor risk, and/or inefficiency in kidney allocation may have played some role. Efforts to reduce risk aversion and improve allocation may help improve utilization, as may more frequent pump perfusion of less-than-ideal but potentially transplantable kidneys.

Nominees Chosen for Board of Directors Election

At its December 2016 meeting, the OPTN/UNOS Board of Directors approved the following slate of nominees for Board appointments beginning in July 2017. The UNOS Board of Directors also functions as the OPTN Board of Directors.

OPTN/UNOS member voting representatives will receive a ballot and biographical information for the nominees in early 2017.

President (vote for one)

  • Yolanda Becker, M.D. , University of Chicago Medical Center

Vice President/President-Elect (vote for one)

  • Sue Dunn,, RN, B.S.N., M.B.A., Donor Alliance
  • Jeffrey Orlowski, M.S., CPTC, LifeShare Donor Services of Oklahoma

Treasurer (vote for one)

  • David Axelrod, M.D., M.B.A., FACS, Vidant Medical Center
  • David Reich, M.D., FACS, Hahnemann University Hospital

Immediate Past President (vote for one)

  • Stuart Sweet, M.D., Ph.D., St. Louis Children’s Hospital

Regional Councillors (vote for five)

  • Region 1 Stefan Tullius, M.D., Ph.D., Brigham and Women’s Hospital
  • Region 2 Matthew Cooper, M.D., Georgetown University Medical Center
  • Region 8 Timothy Schmitt, M.D., FACS , University of Kansas Hospital
  • Region 10 Todd Pesavento, M.D., Ohio State University Medical Center
  • Region 11 Kenneth Brayman, M.D., Ph.D., University of Virginia Health System

Minority Transplant (vote for one)

  • Juan Carlos Caicedo, M.D., Professional Representative Northwestern Memorial Hospital
  • Akinlolu Ojo, M.D., M.P.H., Ph.D., M.B.A. University of Michigan Medical Center

Patient and Donor Affairs Representatives (Donor Family) (vote for one)

  • Tara Storch
  • Bob Veith, B.S., M.S. 

Patient and Donor Affairs Representatives (Living Donor) (vote for two)

  • William Freeman, M.D., M.P.H.
  • Macey Henderson, J.D., Ph.D.
  • Heather Hunt, J.D.
  • Megan Lewis, Ph.D.

At Large OPO Representative (vote for one)

  • Charles Alexander, RN, M.B.A., The Living Legacy Foundation of Maryland

Histocompatibility Representative (vote for one)

  • John Schmitz, Ph.D., Histocompatibility Laboratory at UNC Hospitals

Transplant Coordinator Representative (vote for one)

  • F. Danyel Gooch, M.S.N., RN, CCTC, Indiana University Health

United Network for Organ Sharing (UNOS) serves as the Organ Procurement and Transplantation Network (OPTN) by contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation. The OPTN brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy.

OPTN/UNOS Board approves revised adult heart allocation system, clarifies exception points for liver transplant candidates with hepatocellular carcinoma

St. Louis – The OPTN/UNOS Board of Directors, at its meeting Dec. 5 and 6, approved a major update of the system used to allocate hearts for adult transplant candidates nationwide.

“These are significant changes, meant to address rapid developments in the technology of cardiac care and ensure we are fairly addressing the needs of all patients,” said Stuart Sweet, M.D., Ph.D., OPTN/UNOS President. “We believe this new system will reduce waiting list deaths by providing the most urgent candidates more immediate access to available organs.”

The newly approved heart policy establishes six new medical urgency status levels to replace the current three used to prioritize adult heart candidates. Each status assesses candidates’ relative risk of dying short-term without a transplant. Since the most recent substantive revision of heart allocation policy in 2006, use of mechanical circulatory support such as ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) has become much more common; the updated statuses provide more detailed criteria for when and how these treatments are used for individual candidates.

The policy also alters the sequence of allocation for the most urgent candidates. Hearts from deceased donors age 18 years or older will be offered first to compatible adult status 1 and pediatric (younger than 18) status 1A candidates within the local donation service area (DSA) plus a 500-mile radius from the donor hospital, then to compatible adult status 2 candidates within the DSA plus a 500-mile radius. While the overall number of candidates in the highest two statuses will be relatively small, they are at the greatest risk of dying imminently without a transplant. If no matches are made for these candidates, hearts will then be offered to candidates in lower urgency statuses beginning at the local DSA. The new system will also incorporate a detailed monitoring plan to help ensure the new statuses accurately reflect the current level of candidates’ medical urgency.

In other action, the Board approved policy changes to refine automatic approval of exception points for liver transplant candidates with hepatocellular carcinoma (HCC), a form of liver cancer. Patients with HCC often can benefit from a timely liver transplant, but their disease tends to progress in a way not accurately reflected by the Model for End-Stage Liver Disease (MELD) formula. For this reason, HCC candidates that meet qualifying medical criteria are granted exception scores that better reflect the candidate’s disease severity. The modified policy updates and clarifies criteria for automatic approval to increase equity in access to transplantation between HCC candidates and non-HCC candidates.

While no Board action was planned or taken to address liver distribution, the Board hosted additional public discussion about the status of efforts to reduce the disparity in medical urgency scores at transplant encountered by liver transplant candidates in different areas of the country. The Liver and Intestinal Organ Transplantation Committee will consider this input as it continues to study various alternatives, with the goal of developing a revised policy proposal in the near future.

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 United Network for Organ Sharing (UNOS). The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.

Probation ended for Baptist Memorial Hospital

St. Louis – At its meeting today, the OPTN Board of Directors restored full member privileges for Baptist Memorial Hospital, a member transplant hospital in Memphis, Tennessee.

The board had placed the hospital on probation in October 2014 to address concerns relating to a pattern of lower-than-expected patient and graft survival rates at its heart transplant program. More recent outcomes for heart recipients transplanted at the hospital have shown improvement. 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 United Network for Organ Sharing (UNOS). The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.