Matthew Cooper, M.D. emphasizes collaboration before nation’s transplant surgeons

Recently, I had the opportunity to speak with members of the American Society of Transplant Surgeons (ASTS) during our annual Winter Symposium.

I discussed UNOS’ ongoing improvement efforts and the work UNOS has undertaken in its capacity as the OPTN. Ten minutes weren’t nearly enough time to cover all of the critical work being done to drive improvement and save lives. Instead, I focused on specific areas, including equity and access, outreach and collaboration and patient engagement.

I discussed the many ways in which the national system has undertaken significant steps to improve. We agree with Congress and others that there are many more opportunities we must take advantage of in order to best serve patients and save more lives. I also shared my concerns about those calling for a complete overhaul of the system. These kinds of suggestions don’t serve patients, families or communities well.

Instead, we should remain focused on collaboration, cooperation, and continued advocacy in our never-ending effort to do better and be better for all patients.

Equity and access

Last year, the OPTN Board approved a policy that requires race-neutral calculations be used when measuring kidney function and adding a patient to the waitlist. In December, the board approved an additional policy that requires Black patients who may have been disadvantaged by the earlier use of race-based equations to receive corrected wait times.

Many ASTS members helped push these polices forward, and I appreciate their regular engagement with the OPTN Board and committees.

There have also been steps taken to address geographic equity, including the work of the National Liver Review Board, which has done tremendous things in improving equitable access to donor livers around the country.

We’ve also seen equity and access increase following certain policy changes. The board implemented a new heart allocation policy in 2018. Today, we’re transplanting more urgent heart candidates than we were prior to the policy’s adoption. Similarly, following changes to liver allocation policy, we’re seeing more of the sickest patients receive transplants.

These are just a few examples of ongoing efforts that will expand access to lifesaving treatment. We are also continuing discussions aimed at prioritization of multi-organ transplants versus single organ candidates. Additionally, all OPTN organ-specific committees are working with our community in the implementation of the continuous distribution framework.

Outreach and collaboration

We recognize that we don’t need to reinvent the wheel to drive improvement. Instead, it is essential that we identify where expertise exists outside the organization, and then establish collaborations with those who want to be a part of the success of the nation’s donation and transplantation system.

UNOS continues to work with some outstanding partners, including the Scientific Registry of Transplant Recipients (SRTR), who are collaborating with us on the important work of the OPTN policy committees to bring continuous distribution into reality. We’re also partnering with MIT, Accenture, Microsoft and other leaders in the science and technology fields to continue driving improvements, building upon the national system and ultimately, saving more lives.

As an example, one of our collaborations with Accenture focused on developing a predictive analytics tool, designed to improve decision-making, speed up the acceptance process, get organs to best-fit candidates faster and reduce non-utilization of kidneys. The OPTN recently rolled out this tool.

We are also engaged in ongoing collaborations with federal agencies. We’re committed to working with Congress on a variety of issues, including those of particular interest to the Senate Committee on Finance; issues like transportation. Their emphasis, coupled with a letter I and other leaders on the UNOS board sent to the Secretary of Transportation, will hopefully help us improve the transportation of organs around the country via commercial airline. We are also in ongoing conversations with members of Congress, and we are hopeful that these efforts will open more doors and spur improvement.

Patient engagement

There is a need for an increased focus on patient centered decision-making, objectives and metrics. This is going to be essential moving forward and the National Academies of Sciences, Engineering, and Medicine (NASEM) report, Congress, UNOS and the wider community identified this as critical. As I said in my presentation, we expect and endorse efforts to increase patient involvement in decision-making, and I invited the members of ASTS to stay involved in this process, which directly impacts surgeons who often are both decision-makers for organ acceptance and uniquely involved in the surgical consenting process.

In my closing remarks, I reiterated that as we celebrate milestones, honor donors and their families, and pursue the work that will get us to the next million even faster, I hope we can accomplish even more by partnering with ASTS and others across the community. Ultimately, the best outcome for patients in this country will be achieved by working together collaboratively to drive improvement rather than being divided.