An OPTN/UNOS Board-approved project to improve organ offer and acceptance process resulted in changes to DonorNet® and policy in May and June 2018. The following questions and answers were prepared help OPO and transplant center staff members get ready for the changes.
Phase 1: Reduce the current time limits for responding to organ offers from two hours to one hour
How will this policy impact the amount of time transplant hospitals have to respond to organ offers?
Currently, transplant hospitals have one hour to access the donor information in the match system and an additional hour to refuse the offer or enter a provisional yes. The policy change will require transplant hospitals receiving initial offers to access the donor information and submit a provisional yes or an organ offer refusal within one hour.
What happens if the transplant hospitals do not respond within the timeframe?
The OPO can offer the organ to transplant hospitals for the next candidate on the match run.
How will the system notify transplant hospitals of initial organ offers?
Initial notifications will remain unchanged. If the organ offer is not acknowledged after 10 minutes, the system will send a second notification to the primary and secondary contact. If no response after an additional 10 minutes (20 minutes after initial notification), the system will notify the primary and secondary contact.
What happens when a transplant hospital is the primary offer or becomes the primary offer?
If a transplant hospital is primary for a candidate on the initial offer, they will have one hour from the time the OPO notifies them of primary status and all donor information required by Policy 2.11 has been provided to respond to the OPO with an organ offer acceptance or refusal.
If a transplant hospital was not the primary center on the initial offer and has previously entered a provisional yes for a candidate, then becomes the primary center, they will have 30 minutes from the time the OPO notifies them of primary status and all donor information required in Policy 2.11 has been provided to respond to the OPO with an organ offer acceptance or refusal.
Policy 5.6.B makes it permissible but does not require OPOs to move on to the next candidate on the list if a decision is not made within the timeframes outlined in the policy (60 minutes for initial primary center, 30 minutes if previous provisional yes has been entered and center becomes primary). Ongoing communication between OPOs and transplant hospitals is extremely important when placing organs. There will always be a need for OPOs and transplant hospitals to communicate while trying to get the right organs placed with the right candidates within a reasonable amount of time.
Will DonorNet still display the time left to respond?
Yes, the current “notification time remaining” and “evaluation time remaining” will change to “time to respond” on the organ offers page for active notifications and evaluation offers.
Notify as Primary/Backup Notification Tool
This optional DonorNet® feature enables OPOs to notify transplant hospitals who have entered a provisional yes that their candidate is either the primary or back-up on a match. The additional notification is meant to expedite the organ offer process by keeping transplant hospitals more informed regarding their candidate’s relative position on the match and allows the transplant hospital to be prepared when an OPO calls to notify them of primary.
This tool must not be used to start the clock on the timeframes referenced in Policy 5.6.B. These timeframes are dependent on the required deceased donor information in Policy 2.11 as well as additional information as agreed upon by the OPO and transplant hospital. The use of this tool is optional and OPOs must still initiate contact with the transplant hospital by phone. If OPOs use this tool, it is recommended that they wait 10-15 minutes to allow the transplant hospital to review the message before making a follow up phone call.
Phase 2: Limit the number of organ offer acceptances to two
How will the system count organ offer acceptances?
Acceptances will only count toward the limit if the match is still open AND the OPO has not completed the organ disposition (donor feedback). If the match is just locked, the acceptance will continue to count. If the OPO closes the match or completes donor feedback, then the acceptance no longer counts toward the limit and will not display in the offer acceptance detail section. Additionally, an acceptance will not count for a given candidate once a recipient has been removed from the Waitlist as transplanted for the same donor ID and same organ (and laterality). Per Policy 3.9 (Removing Candidates from the Waiting List), candidates must be removed from the waiting list within 24 hours of transplant.
Acceptances entered before implementation will be included in the acceptance count. This means that if a transplant center has accepted more than two offers for a candidate before implementation then the offer acceptance detail section will display all of these acceptances and the system will prevent additional acceptances from being entered until the acceptance count drops below the limit. As OPOs close out matches and complete organ disposition (donor feedback) these acceptances will no longer count toward the limit and will not appear in the offer acceptance detail section.
How will a transplant hospital know when their candidate has reached the limit of organ offer acceptances?
Transplant hospitals will see a warning that their candidate has reached the maximum number of organ offers. Offer acceptance information will be displayed in the “offer details” section.
How will an OPO know when a transplant candidate has reached the limit of organ offer acceptances?
OPOs will be notified when a candidate has reached the maximum number of offers. This information will be displayed in the “offer details” section in DonorNet. The system will not allow the OPO to enter a third acceptance for that candidate. There is a link to an organ offer acceptance report that will display additional information about all offer acceptances for the candidate.
Will a transplant candidate still receive organ offers if they have reached the limit?
Yes, all candidates will continue to receive organ offers and transplant hospitals can still enter provisional yes acceptances. A provisional yes does not count towards the limit.
What does a transplant hospital need to do in order to accept an additional offer?
The transplant hospital will need to contact one of the host OPOs (for the previously accepted offers) so the OPO can change the one of the previous acceptances to an organ offer refusal.
What are an OPO’s options when a transplant center has reached the limit and they want to accept a third organ for the same candidate?
An OPO cannot enter a third acceptance. The transplant center must contact one of the host OPOs to refuse one of the previously accepted offers.
What are the options for reaching an OPO in order to decline an offer?
The transplant program should use the OPO Contact Number at the top of the match or the OPO contact number in the acceptance details to contact the coordinator responsible for that donor. OPOs should keep this number updated even after all organs have been allocated. If the OPO does not respond, the transplant program should utilize the “Member Main Phone Contact” tool on the Waitlist, under “Resources”. The UNOS Organ Center can assist in providing contact numbers but cannot enter a refusal on a match run for a case that has not been offered through the Organ Center.
What are the OPO requirements for managing organ offer acceptances?
Policy 5.6.B does not require OPOs to enter a final acceptance (“organ placed”) into the system until all information according to Policy 2.11 (Required Deceased Donor Information) is available to the transplant hospitals. While Policy 5.6.C states that the “host OPO must immediately report transplant hospital organ offer acceptances to the OPTN Contractor” there still needs to be ongoing communication between OPOs and transplant hospitals regarding the required information and any additional information, such as kidney laterality, needed to make that final decision. Once there is agreement on this information then the organ offer acceptance must be entered on the match run. This requirement is necessary in order for organ offer acceptance to be monitored in real time.