Region 7 Feedback Session Notes
Fall 2014
Increase the Number of Transplants









Current metrics and goals lead to a hesitancy of an OPO to pursue single organ donors. One
more organ equates to one more transplant.
Identification of ways to measure transplant centers that allow them to use marginal donors
with less risk of being flagged. Increasing transplant is going to rely on using more marginal and
older donors. The current metrics disincentives the use of these donors.
Develop an accurate picture of where a DSAs true organ potential lies. This will identify if
broader sharing in an area to increase transplant is needed or if the local OPO needs assistance
in maximizing its organ potential.
Increasing living donation has the greatest potential for increasing transplants. Currently, there
are barriers that create disincentives not only for donors but for transplant program. The
disadvantaged for donors are mostly financial and there should be attention paid to how UNOS
can move the needle on gaining support to alleviate this disincentive. For transplant programs,
the work load of the follow-up increases the difficulty in growing a living donor program. The
healthy standard donor potentially does not need to be followed for 2 years where the donor
with a higher risk of future complications (donor with a history of hypertension) may need to be
followed for longer. This type of long term data collection would provide meaningful
information that could be used when discussing potential donation as well as providing
guidance to programs when selecting from of a pool of potential living donors for a particular
candidate.
An avenue to increase transplants is through optimizing the use of splits. The OPTN should
consider providing standard outcome data on splits as well as developing some mandatory
parameters for requiring splitting livers.
Maximize the use of best practices in donor management. The OPTN should identify and track
donor management strategies that lead to increases in organ yield.
The OPTN should partner with other profession organization to increase the acceptability of
presumed consent which could potentially lead to an increase in the number of organs available
for transplant.
Analysis current policies around DCD to remove potential barriers to consent and donation.
Investigate causes and potential solutions for discards and non-procured organs.
Increase Access to Transplant



Continue to work with regulatory agencies and the SRTR to decrease the disincentive for listing
and transplanting older candidates and candidates with co-morbidities. This population of
patients will experience the largest decrease in their access to transplant as centers become
more risk adverse. There are unintended consequences when metrics are put into place and as
part of implementation there needs to be a thorough review if the metric has impacted access
to transplant for patients in a particular service areas.
Conduct research to see where the waitlists differ from the ESRD patient population. Identify
why these differences occur, identify disadvantaged demographics and see if there are potential
areas that OPTN/UNOS could influence.
Develop tools to assist programs in preparing and explaining transplant services changes to
patients considering which health plan they should participate in as part of the affordable health
Region 7 Feedback Session Notes
Fall 2014

care act. Several plans restrict access to transplant services and patients’ needs to be aware of
this when weighing their options.
Relook at how the OPTN is pushing the concept of broader sharing. In some areas broader
sharing will mean a decrease in the number of organs and organ quality available to local
centers and patients. This will ultimately mean that centers will begin to restrict the number and
type of candidates that they list with their center. UNOS needs to identify the potential number
of candidates in one area with the potential number of donors in that area and see if there is a
misalignment. Potentially decreasing the disparity in one area could increase the disparity in
another area.
Improve Survival of End Stage Organ Failure



The OPTN needs to redefine a “successful transplant”. In many cases if you have an older
candidate it may make sense to use a marginal donor given the expected lifespan of the
candidate and donor organ. Under the current metrics centers are becoming risk adverse and
may choose to not use this donor for fear of a bad outcome. In many cases center can place a
marginal donor into a candidate fully knowing that the expected function is not optimal but
given the candidates prognosis this will enhance their life. As centers become more risk adverse
they will start turning away from these donor/candidate matches which will be a loss for both
systems. All transplants should not be treated equally since all candidates and donor present
with unique clinical issues. The OPTN should develop a rating scale that better identifies
outcomes for marginal donors into potentially risky recipients.
The OPTN should promote living donation by partnering with professional societies, payors, and
state agencies to identify and remove barriers to living donation.
The OPTN needs to re-evaluate the concept of directing organs to the sickest patients and the
incentive this creates to perform futile transplants.
Additional Comments:




Historically all proposals are implemented on a national scale and when there are unintended
consequences it is difficult to develop and implement real time solutions. UNOS should consider
conducting small scale studies for policy changes to analyze these factors prior to implementing
change on a national level.
UNOS should become more involved in pubically promoting living donation.
UNOS should better define its intent when allocating resources to a project and can we
effectively make a positive change given the resources that we currently have at that time.
There needs to an better understanding on the front end if there are resources available to
effectively make a change and make a positive impact on transplantation and donation before
we commit to a project. Members would encourage UNOS to select a few high impact projects
and focus on those to ensure maximium gain. Splitting resources or taking on too many projects
as tend to lead, in the past, to there be no measureable gain for the resources utilized.
The current survey process is ineffective and inconsistent. UNOS needs to work with CMS to
better identify areas of overlap so that centers are not required to dedicate resources to
following similar but slightly different policies as well as being surveyed on processes twice.
UNOS needs to conduct a thoroughly review of the current CMS standards in light of UNOS
Region 7 Feedback Session Notes
Fall 2014
policies and areas where the differences have no substantial impact on the outcome of the
process, need to align with CMS to lessen the burden on transplant centers and OPOS. In
addition, the current UNOS survey process can be drawn out over 6-9 months and we need to
better define what our internal timing is on providing responses back to members to close out
the survey.
High Level Themes


Removing Disincentives and Barriers to Increasing Transplants and Donor Utilization
o Promote single organ donors
o Identify analytical methods that don’t dissuade transplant centers from listing
older candidates and using marginal organs
o Identify where metrics and policies create disincentives for listing a particular
candidate profile which ultimately prevents access to transplant for certain
patients populations.
o Better define what is an expected outcome for an organ for a particular patient
o Test metrics in small setting to identify unintended consequences before moving
to a national adoption.
o Review discard and non-procurement reasons to see if hesitancy to use marginal
organs dedicates this wastage
o Identify and disseminate donor management strategies that increase organ
yield. At this time, donor research on a national scale is very difficult.
o Review current policies for living and deceased donors and see where the
barriers to procurement occur. Develop ways to overcome these barriers and
allow OPO and transplant programs to utilize these donors. (presumed consent,
DCD approach, living donor follow-up)
Living Donation
o Work with appropriate agencies and societies to remove disincentives for living
donation.
o Review current policies to ensure that resources dedicated for data gathering are
beneficial to increasing center and recipient knowledge on living donation.
o Promote living donation on a national level.