The United Network for Organ Sharing is seeking public comment on 8 proposed policy changes. To be heard, go to ( http://www.unos.org/policiesAndBylaws/publicComment/proposals.asp ).
1 Kidney Transplantation Committee and Liver and Intestinal Organ Transplantation Committee -Proposed listing requirements for simultaneous liver-kidney transplant candidates (Policy proposed: 3.5.10 - Simultaneous Liver-Kidney Transplantation)
This proposal would set minimum criteria for candidates listed for simultaneous liver-kidney (SLK) transplantation. The intent of this proposal is first to identify candidates who are unlikely to regain renal function following liver transplantation. These proposed policy changes would provide priority for these candidates to receive a SLK transplant. The goal of this proposal is to improve patient and renal graft survival following SLK transplant.
2 Liver and Intestinal Organ Transplantation Committee - Proposal to create regional distribution of livers for Status 1 liver candidates (Policy affected: 3.6 - Allocation of Livers)
This proposal will create regional distribution of livers for Status 1 candidates. This proposal should give the most urgent candidates waiting for a liver transplant more access to organs.
3 Liver and Intestinal Organ Transplantation Committee - Proposal to create regional distribution of livers for MELD/PELD candidates (Policy affected 3.6 - Allocation of Livers)
This proposal will create regional distribution of livers for MELD/PELD candidates. This proposal should provide those in most need of a liver transplant greater access to organs.
4 Liver and Intestinal Organ Transplantation Committee - Proposal to standardize MELD/PELD exception criteria and scores (Policy affected: 18.104.22.168 - Liver Candidates with Exceptional Cases)
This proposal will establish criteria and MELD/PELD scores for candidates with hepatopulmonary syndrome, cholangiocarcinoma, cystic fibrosis, familial amyloidosis, primary hyperoxaluria, and portopulmonary hypertension. This proposal should provide consistency in scores assigned to liver transplant candidates with these diagnoses.
5 Thoracic Organ Transplantation Committee - Proposal to add the factors current bilirubin and change in bilirubin to the lung allocation score (LAS) (Policy affected: 22.214.171.124 (Candidates Age 12 and Older)
This proposal adds the following two factors to the LAS to better predict a lung transplant candidates waiting list urgency: 1) current bilirubin (for a candidate in any diagnosis group); and 2) change in bilirubin of at least 50% (for a candidate in diagnosis Group B only). Analyses revealed the association between high bilirubin levels and waitlist mortality. The association between current bilirubin of at least 1.0 mg/dL and waiting list mortality has statistical significance. An increase in a lung transplant candidates bilirubin level of 50% or more during a six-month period, when the higher bilirubin value is at least 1.0 mg/dL, increases a diagnosis Group B candidates risk for dying on the waiting list. This association between change in bilirubin of at least 50% and waiting list mortality for candidates in diagnosis Group B (largely candidates diagnosed with pulmonary hypertension) has statistical significance. The Thoracic Committee anticipates that this policy modification will reduce waitlist mortality for a lung transplant candidate, and improve the ability of the LAS to predict a candidates medical urgency for a lung transplant.
6 Living Donor Committee - Proposal to modify the high risk donor policy to protect the confidential health information of potential living donors (Policy affected: 4.1.1 - Communication of Donor History)
All patients must have their health information protected. If the policy is applied in its current form, potential living donors might not be offered an opportunity to discontinue the donation process rather than have their high risk status disclosed. Modification of this policy will protect the health information of high risk potential living donors.
7 Membership and Professional Standards Committee - Proposal to change the OPTN/UNOS Bylaws to clarify the process for reporting changes in key personnel (Bylaw affected: Appendix B, Section II,E (Key Personnel); Appendix B, Attachment 1, Section III (Changes in Key Personnel)
This proposal to change the bylaws will clarify when notification of changes in key personnel should be submitted and will further clarify the expectation that member institutions that cannot comply should voluntarily inactivate or withdraw the affected transplant program. This proposed language places greater emphasis on the submission of complete applications. Additionally, it clarifies the steps that will be taken if the member fails to inform the OPTN Contractor of key personnel changes.
8 Organ Procurement Organization (OPO) Committee - Proposal to clarify, reorganize and update OPTN policies on OPO and transplant center packaging, labeling and shipping practices (Policy affected: 5.0 (Standardized Packaging, Labeling and Transporting of Organs, Vessels and Tissue Typing Materials)
The proposed modifications to Policy 5 will clarify the policy requirements, eliminate redundancy and provide guidance to OPOs and transplant centers when packaging, labeling and shipping organs, vessels and tissue typing materials. The entire content has been reorganized in order to promote clarity. Types of organ packaging are defined, labeling and documentation requirements are clearly delineated for solid organs, tissue typing materials and vessels. Vessel recovery and storage requirements are listed, as is transportation responsibilities for renal, non renal and tissue typing materials. The goal is to prevent organ wastage, to define terms and responsibilities to promote safe and efficient packaging and labeling, and to clearly list the requirements for recovering, storing and using vessels in solid organ transplant recipients. The responsibility for packaging and labeling deceased donor organs is assigned to the Host OPO while the responsibility for packaging and labeling living donor organs is assigned to the transplant center.