OPTN Kidney Paired Donation
Pilot Program
Ruthanne L Hanto RN, MPH
Program Manager, OPTN KPDPP
Regions 4 Meeting
May 11, 2012
OPTN
Discussion
 Data
 Guidelines
and Proposed Policy
 OPTN
KPDPP Process
 Integration with UNetSM
 How
to join
 Webinar information
 Questions
OPTN
DATA
OPTN
Transplant centers who had preformed at least 1
KPD transplant in the U.S.
+ HI
OPTN
Segev, D KPD Consensus Conference April 2012 Dulles
Number of KPD Transplants in
U.S. by Year
500
450
429 430
400
350
300
278
250
228
200
150
100
50
0
111
2
4
6
19
34
27
74
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
OPTN
http://optn.transplant.hrsa.gov/latestData/rptData.asp Living Donor Transplants By Donor
Relation Based on OPTN data as of March 30, 2012
Transplant centers participating in the
OPTN KPDPP
 118*
Transplant centers
 11 Regions
*As of May 9, 2012
OPTN
Candidate and Donor Characteristics
May 3, 2012 Match Run
Candidates
Donors
150
167 (5 NDD)
Blood Type O
67.3% (101)
32.3% (54)
CPRA ≥ 80%
56.7% (85)
Characteristic
Total
Willing to travel to matched center
Willing to ship/accept a shipped kidney
from/to any center
OPTN
7.3% (11)
32.3% (55)
92.7% (139)
97.0% (162)
Total transplants and pending
transplants to date
25
20
15
10
5
0
Oct 2010 - Aug 2011
Transplants
OPTN
Sept 2011 -May 2012
Pending
GUIDELINES/
PROPOSED POLICY
OPTN
Why is the OPTN a Pilot Program?
 To
work out the logistics of KPD prior
to setting policy
 Currently
participating transplant
centers abide by Guidelines
 Guidelines
converted to public policy
– proposal out Spring 2012
OPTN
Starting your KPD Program
 Identify
key personnel
 Put
processes in place
 Get
the word out to your patients
 Identify
OPTN
potential KPD pairs
OPTN Bylaws Requirements
 Approved
 Notify
OPTN Contractor in writing
 Provide
contact
OPTN
living donor kidney program
primary and secondary KPD
Requirements for Participation
 Candidate
• On waiting list
 Donors
• 18yo or older
• Listed in KPD only once
OPTN
OPTN KPDPP Required Consents
 Agreement
 Donor
to Participate Form (separate)
Education Documentation Forms
 Candidate
Education Documentation Forms
 Authorization
for Disclosure of Medical
Information – HIPPA (no template – yet)
 Accepting/shipping
OPTN
a living donor kidney
Data Requirements
 Donor
& Candidate meet requirements
for donation and transplantation
 RequiredR data fields & Eligible* data
fields
 Tissue typing requirements
 ABO verification
 A2 and A2B matching
 Donor and Candidate choices
OPTN
Required Policies
 When/how
matched donors and
candidates can meet (communicate)
OPTN
PROCESS
OPTN
Match Run Announcement
OPTN
Match Run Announcement
OPTN
Match run schedule posted
Data entry deadline
Eligibility reports
emailed date – May 24th
in UNetSM
Match run date
OPTN
Match Run
 Twice/month
OPTN
Types of KPD
OPTN
Donor Chains
OPTN
Prioritization Points
Priority Points Per Candidate
Base match per candidate (based on 200 points for a 2-way match)
100 points
Zero antigen mismatch with the matched donor
200 points
Highly sensitized candidate (CPRA ≥80%)
125 points
Prior living donor status of the candidate
150 points
Pediatric candidate (age <18 years)
100 points
Waiting time accumulated within the KPD program
2 points per match
run
Geographic proximity with the matched donor
(i.e. transplant center, local, regional)
75,50,25 points,
respectively
Candidate’s other antibody specificities present in donor
-5 points
OPTN
Edge Weights
Pair 3
Donor: B
Recipient: A
Pair 4
Donor: A
Recipient: O
525
Pair 1
Donor: A
Recipient: B
OPTN
325
675
Pair 2
Donor: O
Recipient: A
XM+
Match offers
Match
offers
emailed
OPTN
Preliminary
response
deadline
XM deadline
and
exchange
donor
information
Final
acceptance
deadline
Finances
• KPD Financial Recommendations
• KPD Financial Checklist
• KPD Financial Memo
OPTN
KPD Logistics
2
& 3 way exchange same day
 Chains
sequential
 Candidate
receives kidney before donor
donates
 Donor
nephrectomy schedules within 3
weeks of paired candidate’s transplant
OPTN
KPD Logistics
Transporting Kidneys
 Chain
of custody for shipping kidneys
 UNOS
works with center, OPO, courier
in setting up transportation
OPTN
“Every system is perfectly designed to
get the results it is getting”
- Don Berwick
OPTN
Process Improvement
 Increase
the number of match runs
 Decrease matches declined due to HLA
issues
 Allow Bridge Donors in the system
 Decrease matches declined due to
inactive pairs
OPTN
Process Improvement
 Increase
the number of match run
• 1x – 2x/month
 Decrease matches declined due to HLA issues
• HAC
• Donor pre-select
 Allow Bridge Donors in the system
• Proposal out for public comment for bridge donors
 Decrease number of decline due to inactive pairs
• Education
• Eligibility in UNetSM
OPTN
Automated Solution
Released in Phases
 Data
entry
 Eligibility reports
 Donor pre-select
 Display of match offers
 Tracking of matches,acceptance,refusal
 View matched donor information
 Logistics sheet
 Contact information
 Match communication blog
OPTN
Unique to OPTN KPDPP
 Transparency
& Oversight
Points – consistency in
matching
 Priority
 Fully
automated computer system
integrated with UNET™
 No
OPTN
additional OPTN or UNOS fees
HOW TO PARTICIPATE IN THE
OPTN KIDNEY PAIRED
DONATION PILOT PROGRAM
(KPDPP)
OPTN
Entering Pairs in OPTN KPDPP
 Center
signs agreement
 Center
activated in UNet™
 Site
administrator grants staff access
 Enter
OPTN
pairs
Demystifying the OPTN Kidney Paired
Donation Pilot Program
 KPD
Basics
Recording Available
 Guidelines
to KPD Finances: Who Pays for What
Recording available
 Unacceptable
June 20th
 Navigating
antigens in KPD
2:00 – 3:00 PM ET
the Logistics of KPD
July 25th 2:00 – 3:00 PM ET
OPTN
A B DR
DP DQ
Everything you want to know
about the OPTN KPDPP
http://communication.unos.org/2012/02/everything-you-wanted-to-knowaboutthe-optn-kidney-
OPTN