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New policy aims to speed kidney acceptance rates, increase transplants

July 19, 2023, Richmond, VA

The OPTN Board of Directors unanimously approved a new policy that will help more patients receive a lifesaving kidney transplant by getting the right organ to the right patient faster.

United Network for Organ Sharing (UNOS) is the non-profit organization that contracts with the federal government to serve as the nation’s Organ Procurement and Transplantation Network (OPTN).

The new policy will improve the use of the OPTN offer filter tool, allowing offers of donor kidneys to arrive quicker to transplant programs that are most likely to accept them.

The OPTN Offer Filters tool, which has been available to all U.S. kidney transplant programs since 2022 as an “opt in” resource, allows transplant teams to filter out organ offers that they don’t intend to accept. This allows time-sensitive offers to automatically go to patients at programs that have a history of accepting more medically complex organs. Currently, 60% of kidney programs have at least one filter turned on.

The new “opt out” policy passed by the OPTN Board will automatically turn on offer filters specific to each kidney transplant program, based on the program’s acceptance history. Transplant programs will have the option to use these filters, remove them and create their own filters.

Due to the continuously increasing number of organs recovered, as well as the diverse acceptance practices across transplant programs, some organ offers are extended to programs that may have never considered organs with certain clinical or donor characteristics. The use of offer filters is one strategy to help Organ Procurement Organizations (OPOs) allocate in the most efficient manner, while ensuring that transplant programs only receive offers that they have a history of considering and would legitimately consider.

“The ongoing development of the offer filter tool is driven not only by feedback from the donation and transplant community, but by our own firmly held belief that we can never be satisfied with the status quo,” said UNOS CEO Maureen McBride, Ph.D. “This new policy and the impact it will have on patients waiting for the gift of life is a critical step in our never-ending effort to drive improvement and save more lives.”

Default filters are the first phase in a potential transition to mandatory offer filters, which were recommended by the National Academies of Sciences, Engineering and Medicine in its February 2022 report on the nation’s organ donation and transplantation system. The report identified offer acceptance as a “key area for improvement for transplant centers.”

As the number of available organs continues to grow, so does the rate of organ non-use, particularly for kidneys, which are recovered before being accepted. By empowering transplant hospital staff with innovative new tools like offer filters and collaborative best practices, UNOS and the OPTN intend to maximize the potential of every donated organ and ultimately save more lives.

Additional efforts to increase organ use

Predictive Analytics utilizes waitlist and transplant candidate data at the time of a kidney offer to project when patients would receive additional offers, along with the patients’ likelihood of survival during that time without the initial offer. This information enables transplant teams to make informed decisions about the impacts of accepting or declining an organ offer.

Transplant programs that participated in the predictive analytics pilot program demonstrated a 2.9 percentage point increase in offer acceptance compared to earlier.

Transplant Vision (TxVx), currently in early stages of development by UNOS Labs and a digital product development company, will leverage augmented reality technology to scan and digitally reconstruct recovered kidneys. This will help standardize high-quality organ imagery and other long-distance evaluation measurements, such as size and mass used by transplant center teams, to help determine whether to accept an organ offer.

The Offer Acceptance Collaborative is an effort led by UNOS in its role as the OPTN. The collaborative has brought together transplant professionals from more than 80 adult and pediatric transplant programs to share effective practices and provide education on new data and analytical tools. Offer acceptance rates vary widely across the country. The collaborative seeks to bring together larger and small transplant programs from every region to learn from one another, improve organ offer evaluation and acceptance practices, and increase system efficiencies. Long-term results stemming from this work can help inform innovative solutions to organ non-use. By maximizing the utilization potential of each organ, we can increase the lifesaving impact that each deceased donor can make on the system.

UNet Image Sharing is a digital platform developed by UNOS that allows organ procurement organizations (OPOs) to securely upload, view and share high-quality medical imaging studies with transplant hospitals. It is made available through UNet, the technology at the core of the donation and transplant system that powers patient registrations, donor referrals, organ matching and other essential functions used every day by transplant professionals.

UNet Image Sharing was designed with community input that included a robust pilot program and is currently used by 79 percent of OPOs. It enables quicker, more confident decision-making by surgeons evaluating organ offers, which can increase organ acceptance rates and reduce inefficiencies during the organ allocation process.

About UNOS

United Network for Organ Sharing (UNOS) is a non-profit, charitable organization that serves as the Organ Procurement and Transplantation Network (OPTN) under contract with the federal government. The OPTN helps create and define organ allocation and distribution policies that make the best use of donated organs. This process involves continuously evaluating new advances and discoveries so policies can be adapted to best serve patients waiting for transplants. All transplant programs and organ procurement organizations throughout the country are OPTN members and are obligated to follow the policies the OPTN creates for allocating organs.  

UNOS release: Kidney

United Network for Organ Sharing (UNOS) serves as the national donation and transplant system, under contract with the federal government.

TOPIC | Policy
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