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New expedited liver placement policy prevents discards

New expedited liver placement policy prevents discards

Placing deceased donor livers when late turndowns occur gives candidates another option to receive a lifesaving transplant

Even when procurement goes smoothly, and an organ is matched with a patient waiting for a lifesaving transplant, unanticipated things can happen that result in the organ being turned down in an operating room at the very last minute.

For deceased donor livers, which have only a few hours of viability once they are recovered, it’s especially important to find a new recipient as soon as possible so that the organ can be successfully transplanted.

Working with the donation and transplant community, United Network for Organ Sharing has launched a new policy establishing a clear process for the expedited placement of deceased donor whole livers in the event of a late turndown by an intended candidate.

 Robert Hunter, a policy analyst with UNOS

Robert Hunter

UNOS policy analyst

The new approach, approved by the Organ Procurement and Transplantation Network Board of Directors in 2019, clarifies how to place these organs and provides requirements for organ procurement organizations (OPOs) and transplant hospitals when there is a need to expedite placement of deceased donor livers. It also provides a policy-regulated consistent process which can be practiced nationwide.

Robert Hunter, a policy analyst with UNOS who works closely with the OPTN OPO Committee, which developed the policy, recently answered a few questions about expedited liver placement, and provided a glimpse of what to expect.

From an OPO perspective, give us a high-level overview of expedited liver placement policy.

This policy provides a tool for OPOs to make expedited liver offers when the original accepting candidate turns down a liver, and the donor is in the operating room, or in the case of DCD if the withdrawal of life-sustaining measures has been initiated. This allows OPOs to execute screening on the original match run in order to send offers to those transplant programs with candidates who have opted in to receive these offers.

After a transplant hospital evaluates a candidate to accept an expedited liver, walk us through the process of what happens next.

Transplant programs will have to complete donor characteristics they are willing to accept for their candidate, specific to expedited livers. To opt-in, they must be willing to accept a liver procured by another surgeon or team. When opting in candidates to receive expedited offers, keep in mind they must be available for transplant on very short notice as the donor is already in the operating room or withdrawal of life sustaining support has been initiated.

How does the match run indicate which candidates have opted in for expedited placement?

The column in the match run will identify the candidates that have opted in for expedited placement by showing whether the candidate is willing to accept a liver procured by another surgeon or team. This will allow OPOs to identify candidates as they determine if initiating expedited placement would place the liver quickest and how many offers to send out in order to get the liver placed.

Do patients need an acceptance on the match run to initiate expedited placement or is a provisional “yes” sufficient?

Yes, there must be an original acceptance of the liver in order to initiate expedited placement. Once that acceptance has been changed to a refusal by the OPO, they will have the ability to launch the expedited wizard to begin expedited placement.

Learn more about how UNOS helps get the right organ to the right patient, at the right time.

The transplant community works together to make the system even better. Prior to implementation of the expedited liver policy, many in the organ donation and transplant community had questions about how late turndowns were handled, and were looking for consistent guidance to help preserve candidates’ access to a lifesaving liver transplant.
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