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Committee defines key drivers of system performance

The OPTN/UNOS Ad Hoc Systems Performance Committee met Oct. 29 and 30 in Chicago. Each of the three workgroups (OPO, Transplant Center and Systems Performance) broke into subgroups to define what factors most affect the performance of the transplant system.

Over the next few months, the committee will identify specific metrics, tools, projects and efforts that measure or support system performance.

The committee will present their work at a two-day public meeting March 11 – 12, 2019. Invited speakers will present on related topics and the committee will gather feedback from the audience.

“March isn’t the finish line, but a starting point. The ideas the workgroups generate will be used to measure and improve the transplant system for years to come,” said Matthew Cooper, M.D., System Performance Committee co-chair.

Committee leadership will report to the OPTN/UNOS board of directors at their scheduled meeting in June 2019.

Ad Hoc Committee formed to address OPO, transplant center, system metrics

Liver distribution proposal advances for board consideration

Chicago – The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee, at its meeting Nov. 2, voted to advance a proposal to revise liver distribution policy for a final vote by the OPTN/UNOS Board of Directors at its Dec. 3-4 meeting. The proposal is intended to establish greater consistency in the geographic areas used to match liver transplant candidates with available organs from most adult deceased donors and reduce geographic differences in liver transplant access.
“We believe this reflects a commitment to transplant the most urgent candidates while balancing a number of key issues affecting the liver transplant process,” said committee chair Julie Heimbach, M.D. “We’re committed to closely monitoring the impact of this policy and to making modifications if further optimizations are identified.”
The proposal would replace fixed, irregular local and regional geographic boundaries historically used to match liver candidates based on the donor location. It would initially prioritize liver offers from most deceased adult donors in the following sequence:

  • the most medically urgent candidates (Status 1A and 1B) listed at transplant hospitals within a radius of 500 nautical miles of the donor hospital
  • candidates with a MELD or PELD score of 29 or higher listed at transplant hospitals within a radius of 250 nautical miles from the donor hospital
  • candidates with a MELD or PELD score between 15 and 28 listed at transplant hospitals within a radius of 150 miles from the donor hospital

Livers from deceased donors older than age 70, and/or those who die as a result of cardiorespiratory failure, will be exempt from this distribution. Most of these organs are accepted for local candidates, since they are most viable when the preservation time between recovery and transplantation is short. In addition, this distribution sequence would not apply to livers from deceased donors younger than age 18, which are preferentially considered for pediatric transplant candidates.

The committee further recommended that the implementation of revised liver distribution policy occur no sooner than three months from the pending implementation of a new National Liver Review Board (NLRB), which is scheduled to occur in early 2019. Also, upon NRLB implementation, the committee recommended that standardized exception scores for liver candidates be capped at 28, so that candidates with these scores would not outgain priority for urgent candidates based on calculated MELD/PELD scores. Transplant hospitals, using their medical judgment, may request exception scores higher than 28 from the NLRB for individual candidates.

Simulation modeling of the proposed changes indicate they would reduce variation in transplants by MELD score that exist in various areas of the country under the current liver distribution system. Modeling further predicts that the changes should reduce pre-transplant deaths and increase access for liver transplant candidates younger than age 18. In addition to modeling results, the committee reviewed opinions, recommendations and questions from more than 1,200 public comments submitted between Oct. 8 and Nov. 1.

UNOS wins contract to continue as national transplant network

Richmond, VA – United Network for Organ Sharing (UNOS) has again won a competitive federal contract to serve as the nation’s Organ Procurement and Transplantation Network (OPTN). UNOS has fulfilled this role since the OPTN began in 1986, under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services (HHS).

“UNOS is committed to continually improving the nation’s transplant system,” said UNOS Chief Executive Officer Brian Shepard. “Donors, their families, and waiting transplant candidates depend on us.”

Last year, the number of organ transplants in the United States reached a new high for the fifth consecutive year, and the number of transplants is expected to exceed 36,000 in 2018.

All transplant hospitals and organ procurement organizations nationwide are members of the OPTN. The OPTN contract requires a number of critical functions, including:

  • developing and implementing equitable organ distribution policies
  • collecting detailed data on all transplant candidates and recipients, as well as living and deceased organ donors
  • conducting research to improve performance of the national transplant system
  • assisting in organ placement for transplantation
  • monitoring members for patient safety and quality
  • reviewing issues involving potential risks to the health and safety of transplant candidates, recipients and/or living donors

Including option years, the new contract will run through September 2023. Total funding over the length of the contract is estimated to be nearly $250 million. The federal government will fund approximately 10 percent of that amount. The remainder of contract funding comes from fees assessed to individual member institutions.

Areas of additional emphasis under the new contract include:

  • enhancing professional and public involvement in OPTN policy development, such as developing and hosting professional symposia on key policy-related issues
  • continuing to foster innovation in providing projects and services to increase organ utilization and improve the organ matching process
  • furthering the development and use of metrics in assessing the effectiveness of OPTN policy implementation and of monitoring members for patient safety and quality

Separate from its OPTN responsibilities and with private funding, UNOS, a non-profit, 501(c)3 charitable membership organization, leads other efforts to support organ donation and transplantation. These activities include:

  •  collaborating with members on continuous improvement initiatives to strengthen and enhance their work
  • conducting innovative research to increase the number of transplants and enhance transplant outcomes
  • offering information to guide potential living donors, transplant candidates and their caregivers in their decision-making

UNOS is based in downtown Richmond, Va. UNOS is also the home of the National Donor Memorial to honor the spirit and the legacy of organ and tissue donors.

Learn more about National Liver Review Board

Webinar registration opens Nov. 6.

UNOS will implement the National Liver Review Board (NLRB) in early 2019.  UNOS is offering a series of educational events to help you prepare for these changes.  The following chart shows upcoming educational opportunities.  It will be updated as more details are available.

Registration for the December 13 live webinar will open November 6.  To register, visit UNOS Connect.  You can access it through the Home page, or click into the Live Webinar Course Catalog Category. After registration, you will receive a confirmation e-mail with instructions on how to get the webinar link.  If you are attending the webinar as part of a group viewing, you must first register in UNOS Connect in order to receive credit for taking the course.  This event will be recorded and posted to UNOS Connect within seven business days for later viewing.

Please note: Liver distribution policy will be implemented early in 2019 after NLRB.  We will update this article with information on educational offerings relating to liver distribution as they are scheduled.

Date Topic/synopsis How to access/learn more
Dec. 6 National Liver Review Board policy: MELD/PELD exception scoring

In addition to the structure of the new NLRB, candidates meeting the criteria for standardized exceptions will be assigned MELD/PELD exception scores in a different way. This offering explains the new MELD/PELD exception scoring that will be implemented with NLRB in 2019.

UNOS Connect
Dec. 13;
3-4 p.m. (EST)
National Liver Review Board policy: New processes

This live webinar will outline the new review board structure and explain what members need to know about submitting MELD/PELD exception requests, the appeals process, and how existing exceptions and unresolved forms will be transitioned.  The event will be recorded and posted to UNOS Connect within seven business days of the live event.

UNOS Connect
Dec. 18 NLRB training for review board representatives UNOS Connect

Your UNet security administrator helps keep UNOS systems safe

Each October, UNOS observes Security Awareness Month by training staff and sharing best practices to protect UNOS systems and keep patient information safe. We also wanted to take this time to highlight an important partner in our collective efforts: UNet security administrators at OPTN member transplant hospitals, OPOs and histocompatibility labs.

If you use UNOS systems as part of your job in organ procurement or transplant, your security administrator gave you permissions to access DonorNet®, WaitlistSM, TransNet, KPDSM system, Patient Safety Reporting, and/or TIEDI®. We rely on security administrators to provide individuals with the right level of permissions they need to perform their job. They are also responsible to notify UNOS Membership as soon as possible when a UNet user changes roles or leaves the organization.

Security administrators review and update UNet permissions each year. They also notify UNOS when there is a personnel change. UNet users can access a self-service feature to change passwords and update certain information.

We heard you! Revamping security administration site

Security administrators have told us that their UNet site could use some improvements, and we asked them for specifics. We plan to update the security administration site in 2019 to improve the flow and functions on the site, to make it easier to use. We look forward to collaborating with users to make sure that we are moving in the right direction with changes.

If you have questions or suggestions, contact UNOS Customer Service (UNet Help Desk) at 1-800-978-4334 or unethelpdesk@unos.org.

 

HLA equivalency tables are changing in Dec. to include new values and other enhancements

Audience:

  • Transplant hospital staff
  • OPOs
  • Histocompatibility lab staff
  • OPTN KPD program participants

Please share this information with anyone in your organization who would benefit.

Implementation date:
December 5, 2018

At-a-glance:
Every year, the OPTN/UNOS Board of Directors review and approve changes to the HLA and unacceptable antigen equivalency tables. We are in the process of updating those tables now and the changes will take effect Dec. 5, 2018. At that time, you’ll notice changes to HLA and the unacceptable antigen dropdown menus throughout the UNet, DonorNet, Waitlist, TIEDI and KPD applications. We’ll outline what is specifically changing below. It is important that you familiarize yourself with everything new.

What specific changes are coming?

Removals/relabeling
We are removing and relabeling two values throughout the entire system.

  • B4415 will now display as B44
  • DR103 will now display as DR01:03

Additional dropdown selections

You will see additional values for all loci (except HLA-DQA1). For DR51, DR52, DR53, you will see the following new values:

DR51: 5*01, 5*01:01, 5*01:02, 5*02, 5*02:02
DR52: 3*01, 3*01:01, 3*02, 3*02:01, 3*02:02, 3*03, 3*03:01
DR53: 4*01, 4*01:01, 4*01:03

CPRA calculation changes
Whenever we modify unacceptable antigens, candidate CPRA scores may change slightly.

New features:

Unacceptable antigen section in Waitlist and KPD and CPRA calculator:
You will now be able to either manually add unacceptable antigens (the way you have been doing) or you copy and paste a comma delimited list of unacceptable antigen values (ex. A1,A01:01,DR01:01,DR523*01:01). We are changing the look of the Waitlist CPRA calculator in the Reports section so that it resembles this new unacceptable antigen portion on a candidate page.

The candidate page is now an additional place where you can calculate CPRA. You will now be able to see real-time changes in the CPRA score but it won’t be stored until you hit the save button.

Import Unacceptable Antigens to Active Waiting List 
If you used this feature in the past, you needed to know how the antigen code was labeled in the database, which may have differed from what you saw in UNet.
For example:

Currently, an import file may look like this:
A201, BW4, DR0401, DR5252
Upon implementation, the import file should look like this:
A02:01, BW4, DR04:01, DR525*01:01

KPD eligibility:
If you have entered an HLA value for your candidate under DR51, DR52, or DR53, we will automatically prefill a newly created second dropdown column with a negative value. This ensures that your candidate does not become ineligible for the organ offer.

Policy Resources:
You’ll find the Antigen Equivalence tables in Policy 4, located on the OPTN website.
This policy notice explains the board’s responsibility for reviewing and approving equivalency table updates each year.

Contact:
If you have questions about these system changes, please contact the UNet Help Desk at (800) 978-4334. For general questions, particularly those related to compliance, monitoring or policy, please contact your UNOS Regional Administrator at 804-782-4800.