Notice of implementation: Removal of DSA and region from kidney and pancreas allocation

Notice of implementation: Removal of DSA and region from kidney and pancreas allocation

Audience:

OPO:

  • Primary OPO Administrative Directors, Primary Data Coordinators
  • Organ Procurement Adms/Mgrs, Regulatory Affairs Coordinators/Managers, Compliance Officers, Data Coordinators, OPO Quality Managers/Coordinators, Quality Coordinators, Quality Directors/Managers, Organ Placement Coordinators, Organ Procurement Coordinators, Organ Procurement Adms/Mgrs

TXC: Kidney and pancreas

  • Primary Program Administrators, Primary Data Coordinators, Primary Physicians, Primary Surgeons
  • TX Program Administrators/Managers, TX Program Directors, TX Program Medical Directors, Clinical Training Coordinators/Managers, TX Program – Clinical Coordinators, Support Staff-Clinical, Data Coordinators, Regulatory Affairs Coordinators/Managers, Compliance Officers, Quality Directors/Managers, Quality Coordinators, TX Program Surgical Directors, TX Surgeons,

Histo Lab:

  • Primary Lab Directors 1, Primary Lab Directors 2, Primary Technical Supervisors
  • Histo Lab Adms/Managers

The Board of Directors of the Organ Procurement and Transplantation Network

OPTN Representatives and Alternate Representatives

The OPTN Kidney Transplantation Committee

The OPTN Organ Procurement Organization Committee

The OPTN Pancreas Transplantation Committee


Implementation date: March 15, 2021

At-a-glance

The Organ Procurement and Transplantation Network has implemented policies to remove donation service area (DSA) and OPTN region from kidney and pancreas allocation.

The OPTN has previously eliminated DSA and region from the allocation systems of all other organ types and replaced them with a distance-based approach. In the new system for kidney and pancreas allocation, the first unit of distribution is no longer DSA and is now a 250 nautical mile (NM) circle around the donor hospital. Removing DSA and region from kidney and pancreas distribution is intended to create greater equity in access to transplantation for candidates regardless of where they live.

Additional changes involve allocation of kidneys and pancreata from Alaska, and a new definition for and prioritization of medically urgent kidney candidates. The policies also change how released kidneys, pancreata, kidney-pancreas and islets are allocated in the new system when the original intended candidate is not able to be transplanted. Find a summary of changes and details about professional education below. Find answers to frequently asked questions here.

Background

These policies are the result of the OPTN Board of Directors’ 2018 directive that organ-specific committees remove DSA and region from allocation policies in order to align with the OPTN Final Rule. One of the requirements of the Final Rule is that policies “shall not be based on the candidate’s place of residence or place of listing, except to the extent required” by other requirements of the Rule.

Statistical simulation modeling performed by the Scientific Registry of Transplant Recipients (SRTR) projects that the new kidney and pancreas policies will improve transplant access for key groups of transplant candidates, including children, women, ethnic minorities and candidates who are particularly hard to match for biological reasons.

Follow news about kidney and pancreas policy development here.


Summary of changes

Removal of DSA and region from kidney and pancreas allocation

These policy changes remove DSA and region from kidney and pancreas allocation and replace them with a 250 NM fixed circle for purposes of distribution. The policy changes also add increased priority for living donor and pediatric candidates in allocation. Refer to the kidney policy toolkit page and the pancreas policy toolkit page for complete details.

In the new system, candidates receive proximity points that are calculated into their total allocation score. Within 250 NM classifications, candidates will be ranked using a total score including a maximum of two proximity points. Once 250 NM classifications have been exhausted, candidates in national classifications will be ranked using a total score including a maximum of four proximity points. Candidates registered at transplant hospitals farther than 2500 NM from a donor do not receive any proximity points.

This visual aid shows an example of how proximity points impact allocation for candidates inside and outside the circle. Programs can check donor hospital locations within 250 NM by using the map visualization of donor hospitals within 250 NM of transplant programs.

Transplant programs should evaluate their current “local” acceptance criteria settings for candidates in Waitlist℠ and determine if updates are appropriate. Programs can check donor hospital locations within 250 NM by using the map visualization of donor hospitals within 250 NM of transplant programs.

UNetSM users can find additional information about changes to system components in the professional education resources on UNOS Connect and in online help documentation in UNet.

Pancreas programs should know that the yearly update of facilitated pancreas programs coincides with this project and includes data on pancreas transplants from July 2018 – June 2020. The new requirements specify that facilitated pancreas programs must have performed at least two (2) pancreas transplants from donors more than 250 NM away from the transplant program within the previous two (2) years. Read about all the changes to facilitated pancreas allocation in the policy notice to eliminate DSA from pancreas allocation.

Addressing medically urgent candidates in the new kidney allocation system

This policy was developed because the policy to remove DSA and region from kidney allocation eliminated Policy 8.2.a: Exceptions Due to Medical Urgency. The OPTN Board of Directors approved this change in order to provide a consistent definition of medical urgency and also ensure medically urgent candidates receive allocation priority in the new system. Find details about the new medical urgency definition and classifications within all kidney allocation sequences in the policy notice. Find a summary of policy changes and policy documents on the policy toolkit page.

  • Medical urgency data collection period: The period preceded implementation and began March 8, 2021. This data collection period allowed transplant programs to pre-enter medically urgent qualifying information for their kidney candidates so they could receive the new status and priority immediately upon implementation on March 15.

Effective March 15, all kidney candidates with pending medical urgency data pre-filled in Waitlist during the data collection period have been automatically converted to the new medically urgent status (Status 2) and are receiving priority under the revised policy. If current candidate listings that had medically urgent and critical statuses (Status 5 and Status 6) were not updated with new medical urgency qualifying data by March 15, they were converted to active status (Status 1) at implementation. Effective March 15, Status 5 and 6 will no longer exist as status options for kidney candidates.

  • Submitting supporting documentation: The transplant hospital must document the medical urgency qualification in the candidate’s medical record and submit supporting documentation to the OPTN within seven (7) business days of indicating medical urgency status. Transplant programs are able to attach medical urgency supporting documentation to the candidate record inside UNetSM. Find more information, including a list of acceptable file types, in WaitlistSM Help Documentation.

Modifications to released kidney and pancreas allocation

The removal of DSA and region from kidney and pancreas allocation required the modification of policies related to the reallocation of released kidneys and pancreata. The new released organ allocation policies address the reallocation of kidney, kidney-pancreas, pancreas, and islets in situations in which an organ allocated to an original intended recipient is unable to be transplanted in that recipient.

Importing OPOs are no longer able to initiate an import match to identify alternate recipients for these organs. Importing OPOs may still assist with communication and transportation logistics on behalf of transplant hospitals for imported kidneys if requested by the transplant program. This visual aid illustrates the processes for reallocating released kidney, pancreas, kidney-pancreas and islets in the new system.

Find more details in the policy notice of modifications to released kidney and pancreas allocation. Find a summary of changes and guidance on the policy toolkit page.

Distribution of kidneys and pancreata from Alaska

This policy adds Policy 8.7.D: Location of Donor Hospitals and Policy 11.8.A: Location of Donor Hospitals to the kidney and pancreas policies respectively. The change establishes the Seattle-Tacoma airport (Sea-Tac) as the administrative center for the 250 NM circle of allocation for kidneys and pancreata procured in Alaska. Read the policy notice for more details.


Professional education resources

Resources and trainings for professionals at OPOs, transplant hospitals and histocompatibility labs are available on UNOS Connect.

  • KID111: Modifications to Released Kidney and Pancreas Allocation
  • KID112: Removing DSA and Region from Kidney and Pancreas Allocation
  • KID113: Medical Urgency Data Collection Period (previously Phase 1)
  • KID114: Medically Urgent Status for Adult and Pediatric Candidates (previously Phase 2)
  • QLT102D: Notification Limits for Distance-based Allocation
  • QLT103D: Acceptance Criteria for Distance-based Allocation

Find an FAQ here. Find all policy notices and other guidance in the policy toolkits in the Professional Education section of the OPTN website:


Questions?

If you have questions relating to implementation, contact UNOS Customer Service at unethelpdesk@unos.org, or call 800-978-4334 from 8 am to 7 pm EST.

For policy-related questions, contact member.questions@unos.org.

The Organ Center is available around the clock and can be reached at 800-292-9537.

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