Dallas – The Board of Directors of the Organ Procurement and Transplantation Network, at its meeting Dec. 3, approved a new system for matching kidney and pancreas transplant candidates with organs from deceased organ donors. The new policy establishes new distribution areas based on the donor location and is projected to increase equity in transplant access for candidates regardless of where they live or list for a transplant.
“The local and regional boundaries we have used for decades often do not reflect the practical and clinical needs of transplant candidates based on how near or far they are to an organ donor,” said Maryl Johnson, M.D., board president. “The new system is better at addressing distance as a factor in transplant matching. It’s also in keeping with our mandate to make sure that objective medical factors, not geography, should be the key to matching donors and recipients.”
New geographic area for offers; additional priority for candidates closer to donor location
Under the newly approved system, expected to be implemented in 2020, kidney and pancreas offers (except for rare, very well-matched donor and recipient combinations nationwide) will be offered first to candidates listed at transplant hospitals within 250 nautical miles of the donor hospital. Offers not accepted for any of these candidates will then be made for candidates beyond the 250 nautical mile distance.
Candidates also will receive proximity points based on the distance between their transplant program and the donor hospital. Proximity points are intended to improve the efficiency of organ placement by adding priority for candidates closer to the donor hospital. Candidates within the initial 250 nautical mile radius will receive a maximum of two proximity points, while those outside the initial circle will receive a maximum of four proximity points. The point assignment will be highest for those closest to the donor hospital and will decrease as the distance increases.
Differences from current system and predicted benefits
The new system will replace a three-tiered approach used since the beginning of national organ allocation policies in the mid-1980s. Currently, most kidney and pancreas offers go first to candidates listed at hospitals within the same donation service area (DSA) where the donor hospital is located. There are 58 DSAs reflecting the assigned service area of organ procurement organizations (OPOs). These DSAs are fixed, often irregular geographic boundaries, and were not set for the express purpose of optimizing organ allocation. In some instances, portions of the same DSA are not contiguous, meaning that some “local” donor matches may travel through service areas belonging to other OPOs.
Organ offers not accepted at the DSA level currently are made to candidates at hospitals within the same OPTN region as the donor hospital. Finally, offers not accepted at the DSA or regional level are made to candidates listed at transplant programs anywhere else in the United States.
“Under the current system, candidates listed at two different hospitals just a short distance apart from each other, and a short distance from a donor hospital, can appear much higher or lower on a match just because their hospitals are in different DSAs or regions,” Johnson said. “The new policy will remove those artificial distinctions for candidates who are much the same as each other in terms of distance and medical need.” In addition, statistical modeling indicates the policy will increase transplant access for key groups of transplant candidates, including children, women, ethnic minorities and those who are hard to match with many donor offers due to high immune sensitivity.
New procedure to improve liver placement
In other action, the OPTN board approved a policy change to allow more efficient placement of donated livers when a transplant program first accepts a donor offer and then rescinds it late in the recovery process. The update allows livers affected by such late refusals to be offered to transplant programs that opt to be contacted for such offers and that provide specific information in advance regarding the types of offers they would be willing to accept. Making subsequent liver offers first to transplant programs willing to consider them is expected to place the offers more quickly and increase the chance that the liver will be transplanted.
HOPE Act provisions extended
The board also approved a change to the expiration date of the OPTN policy variance supporting the federal HIV Organ Policy Equity Act (HOPE Act). Under the HOPE Act, research is underway to assess the effects of transplantation of organs from donors with HIV to candidates with HIV. The expiration date of the variance has been extended to January 1, 2022, to allow a more robust review of the results of the study.
The board took additional actions as follows:
- Approved a slate of nominees for election to open positions on the board in July 2020
- Accepted clarifications to OPTN data submission and release policies
- Amended the process for selection of the Vice Chair of the OPTN Histocompatibility Committee
- Accepted updates to align units of distribution for a closed split liver variance
- Approved a policy clarifying the definition of pre-existing liver disease
- Approved updates to OPTN committee charters
- Terminated select allocation variances that are no longer applicable or no longer in use
- Approved changes to tables listing histocompatibility antigens and equivalents in OPTN policy
- Referred a list of project ideas to the OPTN Policy Oversight Committee to prioritize with the goal of increasing organ utilization through efficient donor/recipient matching