Definition of Transplant
Policy Oversight Committee (POC)
Fall 2014
The Problem

Questions from OPTN/UNOS members


What is the definition of a transplant?
Which date should be reported as the transplant date?

Current disconnect between policy definitions and
clinical practices

Proposed definitions will help align policy
requirements with current clinical practice
The Problem – Single Organ
Transplants

Patient receives liver transplant, but organ is larger
than expected. Surgical team does not
immediately close the abdomen. Patient is
removed from the OR and dies three days later.

Disconnect: According to current policy, the
transplant was never completed
The Problem- Multi-organ
Transplants

Recipient leaves OR after receiving first organ
transplant and returns to OR next day for a second
organ from same donor

Current policy: date of 2nd organ transplant recorded
as date of first organ’s anastomosis


first transplant could have occurred more than 24 hours
earlier
Disconnect: program could need to remove a patient
from waiting list before the second organ is
transplanted
Goal of the Proposal

Maintain current reporting elements, while
capturing existing clinical practice

Ensure data reported to the OPTN reflect what
actually happens in a single-organ or multi-organ
transplant
How the Proposal will Achieve its Goal
Definition of Organ Transplant

An organ transplant BEGINS at anastomosis of the
organ, and an organ transplant would be
COMPLETE when:
The cavity is closed and final stitch or staple applied
or
The recipient leaves the operating
room, even if the chest or abdominal
cavity cannot be closed
How the Proposal will Achieve its Goal
Definition of Transplant Date:

Transplant date for an organ would be determined
by the start of anastomosis for that organ, so you
could have a multi-organ transplant occur on two
different days

The beginning and completion of an islet infusion
would not change
What Members will Need to Do

Accurately report data based on the proposed
language

Apply the new definitions of organ transplant and
transplant date when reporting in UNetSM
Questions?

Yolanda Becker, MD
Chair, Policy Oversight Committee
ybecker@surgery.bsd.uchicago.edu

Leigh A. Kades, MA
Liaison, Policy Oversight Committee
leigh.kades@unos.org