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Community update: Policy development based on continuous distribution

Community update: Policy development based on continuous distribution

Board of Directors President Matthew Cooper, M.D., provided the following update to UNOS members on August 6, 2021.

Dear colleagues,

By now, you have probably heard the phrase “continuous distribution” as a framework for future national organ allocation policy. Some of you already know it well; others may not know much detail beyond the basic concept.

In short, this will be the fundamental basis of organ allocation going forward. It is in different stages of development by organ type – an update on the status of each is listed below. But we are well on the path to incorporating it as an improvement over the category-based allocation policy that has been in place up to now.

In your feedback to UNOS, you have shown eagerness to learn about and participate in policy development at its formative stage. All of us have a stake, and a voice, in shaping new policy based on this concept. It is necessary, and the right thing to do, for us to proceed in this to make the transplant system as equitable and as efficient as it can be.

Some of these initiatives are now subject to public comment. Others are in earlier stages of development according to a planned schedule. Please become familiar with the issues and share your perspective. A key strength of building policy on the basis of continuous distribution is that the individual weighting and value of the component factors can be adjusted more easily than current policies allow. But we want to make sure from the outset that the parameters we develop reflect the highest consensus we can reach with our collective expertise and experience.

Lung public comment proposal; August 9 webinar

The lung community was the first to begin policy development based on continuous distribution. In the public comment period that began August 3, the Lung Transplantation Committee seeks input on lung allocation policy based on this framework. The proposal builds upon more than three years of study, including public feedback to a concept paper published in the fall of 2019.

Recently performed SRTR modeling suggests the approach currently being considered will reduce wait list deaths, increase transplant rates for pediatric candidates, and reduce variability in transplant rates across regions. Supplemental SRTR analysis based on insurance type suggests a continuous distribution approach would result in a higher rate of transplants among candidates on Medicaid.

The Lung Committee will host a webinar Monday, August 9, to give you an additional opportunity to learn more about the proposal and provide well-informed feedback. It is scheduled to last from 3:30 to 5:00 p.m. EDT. You may register via this link. The webinar will be recorded and available for later reference if you cannot participate live.

Kidney and pancreas concept paper

Also in this public comment period, the Kidney and Pancreas Transplantation Committees invite input on a concept paper. This is not a policy proposal. It does, however summarize the committees’ current consensus assumptions and recommendations on their respective policies.

As with the lung pathway, feedback to the concept document will greatly influence development of a future policy proposal, which will likely be published for public comment in the fall of 2022. Please take this opportunity to review and comment on the committees’ work to date.

Ethics white paper

Yet another item for public comment is the Ethics Committee’s work to date on a white paper, which is intended to outline the ethical principles and standards to guide the development of policy based on continuous distribution. Please review their rationale and recommendations and provide any additional perspective you believe should be included.

Liver and intestinal organs

The Liver and Intestinal Organ Transplantation Committee has begun initial discussion on policy development. As with the other organ systems, the committee expects to develop and publish an initial concept paper and use public feedback to develop a subsequent policy proposal.

Heart and VCA

Policy development for both heart allocation and VCA allocation is expected to begin in 2023. We will continue to keep you informed as the respective committees approach milestones in policy development.

Resources for further information

There is a wealth of information available to help you understand and share your expertise in this new foundation for policy development. Both the OPTN and UNOS websites contain recently updated and enhanced content addressing:

  • the concept of continuous distribution and examples of how it will be applied
  • the framework for policy development
  • the Analytic Hierarchy Process (AHP), which is used to help the transplant community and the public identify and prioritize different attributes to be used in policy

The OPTN continuous distribution resource page explains in greater detail the history of how the continuous distribution framework was developed, as well as summary information on the progress of the committees in developing policy.

The UNOS organ distribution resource page includes additional information on the people, organizations and research efforts involved in this new and innovative approach to policy development.

Together we have a unique opportunity to fundamentally improve the transplant system for the benefit of all we serve. Please share with your peers and the public, so that we may all make the most of this opportunity.

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