Audience:
Staff from OPOs, Histocompatibility Labs, and Transplant Centers
Please share this notice with anyone in your organization who would benefit from this information.
Implementation date:
January 21, 2016
At-a-glance:
Based on policy approved by the OPTN/UNOS Board of Directors, we’ve added four new HLA fields to DonorNet®. If these values are not typed for and entered into the system, Organ Procurement Organizations cannot make organ offers to transplant centers for kidney, kidney-pancreas, pancreas, or pancreas islets. You must enter data for A, B, Bw4, Bw6 and DR antigens for your pancreas islet candidates. For heart, heart-lung, and lung offers, these fields are required before final acceptance if it is requested by a transplant program.
These policy changes also resulted in field label changes within DonorNet, which we explain in detail below.
What OPOs need to know:
When you add a new donor to DonorNet or edit information for an existing donor, you will see four new fields, two for DQA1 and two for DPB1, in the Crossmatch and HLA section. These values will also appear on the page that initiates organ matches. You will be able to update your donor record without entering a value for these fields, but you WILL NOT be able to make any kidney, kidney-pancreas, pancreas, or pancreas islet offers if these fields are empty.
If you are making an offer for any other organs, these fields will appear but they are optional. For heart, heart-lung, and lung offers these fields are required prior to final acceptance if it is required by a transplant program. Liver should report these fields within the period specified by the transplant program.
Also in the Crossmatch and HLA section and on the run the match page, the CW field label has changed to C and DQ label has changed to DQB1.
What Labs need to know:
Beginning January 21, 2016, you must now:
- test for HLA values DQA1 and DPB1 on deceased donors for your OPOs
- conduct antibody screening for DQA1 and DPB1 on transplant candidates for your transplant centers
Very important: For the Import Unacceptable Antigens utility within Waitlist, the CW and DQ labels will no longer work in the import unacceptable antigens file. Your import file must have CW and DQ loci labeled as C and DQB. We have updated the utility to include DQA1 and DPB1. DQA1 and DPB1 values must be labeled as DQA and DPB respectively in your import file. The import field for Locus/Unacceptable Antigen has increased from A(1000) to A(8000).
Example import for the Locus/Unacceptable Antigen field: A6601,A6602,B8201,BW4,C17,C18,DPB438:01,DPB439:01,DQB8,DQB9,DQA06:01,DQA06:02,DR52,DR1403,DR1404
Note: For ambiguities involving “G” alleles, you should report the lowest member of the “G” allele string. For example, if your lab receives an 04:02/105:01 typing result, you should report 04:02.
Within TIEDI, we modified the following fields on the Recipient and Donor Histocompatibility forms:
- The CW label is now C
- The DQB label is now DQB1
- The DPB1* label is now DPB1
- The DQA label is now DQA1
- The DPA1* label is now DPA1
DQA1 and DPB1 dropdowns were modified. Please refer to this spreadsheet to view the list of valid values.
What Transplant Centers need to know:
We’ve added DQA1 and DPB1 to the unacceptable antigens section for all organs in WaitlistSM. Those fields will be used in screening candidates off match runs.
We have redesigned the unacceptable antigens section found on the candidate add and edit pages to improve usability.
You should be aware that certain DPB1 alleles/antigens are not represented in single antigen bead assays. For donors with such DPB1 alleles/antigens, candidates with DPB1 antibodies may not be appropriately excluded from the match run. If your candidate has DPB1 antibodies, you should consult with your local HLA laboratory to make your final assessment of donor compatibility.
DQ and CW labels were relabeled to DQB1 and C, respectively, throughout the Waitlist application.
Also, you must enter data for A, B, Bw4, Bw6 and DR antigens for your pancreas islet candidates, so be sure your lab tests for these values and that you record these values. You will not be able to make changes to your existing pancreas islet candidate data or add new pancreas islet candidates if you have not entered these values.
Additional important information for labs and transplant centers
When entering candidate unacceptable antigens for DQA1, if you select only a parent DQA1 value, it WILL NOT automatically exclude the candidate from donors with the corresponding subtype values.
Beginning January 21, 2016, when entering DQA1 unacceptable values for candidates, you will see this warning message in UNet:
WARNING: For DQA1, select all unacceptable antigens that apply (parent and subtype). For example, if candidate is to be excluded from donors with parent values for DQA1*03, select DQA1*03 (parent) and all subtypes of DQA1*03 (e.g. 03:01, 03:02, etc.). Selecting only value DQA1*03 will NOT exclude donors reported as 03:01, 03:02, etc.
Training
Questions?
If you have policy or general questions about these changes, contact your UNOS Regional Administrator at 804-782-4800. If you have questions related to DonorNet or Waitlist, contact the UNet Help Desk at 800-978-4334.
