2 Current Lung Allocation System System was implemented on May 4, 2005The Lung Allocation Score (LAS) is based on a combination ofExpected survival in next year without a transplant andExpected survival during 1st year with a transplantDetails of calculation and allocation can be found in Policy 3.7.6
3 Components Of Current Lung Allocation System: Diagnosis Groups DiagnosesACOPD/Emphysema; Alpha-1 Antitrypsin Deficiency; Bronchiectasis; LAM; Sarcoidosis with PA mean < 30; Primary Ciliary DyskinesiaBPPH; Eisenmenger's; Scleroderma (primarily Pulmonary HTN)CCF; HypogammaglobulinemiaDIPF; Sarcoidosis with PA mean > 30; Lung retransplant; Obliterative Bronchiolitis (OB); Pulmonary Fibrosis (not IPF); Eosinophilic granuloma; Amyloidosis; Mixed Connective Tissue Disease; Scleroderma (primarily restrictive)These cover about 95% of registrations. Not room for all possible diagnoses on this slide.
4 Number Of Lung And Heart-lung Registrations By LAS Status Active Registrations 12+ Years This slide illustrates decreasing numbers of lung and heart-lung registrations since implementation of the LAS policy. This was expected as waiting time no longer plays a role in allocation and patients do not need to be listed early.N=1667N=1443
5 Active Lung And Heart-Lung Registrations (12+) On July 6, 2005, By Region Number of active lung and heart-lung registrations varies widely by region.
6 LAS for Active Lung And Heart-Lung Registrations (12+) With Nonzero Scores On July 6, 2005, by Diagnosis GroupAge GroupDiagnosis GroupNMedianScoreAdult (18+)ALL110433.12A (COPD)50632.16B (PPH)11532.39C (CF)16334.21D (IPF)32036.26Pediatric(12-17)5833.54432.131331.493133.951036.46Median score for lung and heart lung registrations on the waiting list on 7/6/05 by diagnosis group.
7 Percent Of Lung and Heart-Lung Transplants Pre- And Post- Policy Implementation By Diagnosis group
8 Lung UtilizationMay 4, 2004 – June 3, 2004May 4, 2005 – June 3, 2005N% of donorsDeceased donorsDonors606100.0671Donors with at least 1 lung transplanted8213.511316.8% of lungsDeceased donor lungsLungs (2*donors)12121342Lungs transplanted14912.320515.3
9 Percent of Lungs Transplanted* May 4, 2005 – June 3, 2005 Number of active lung and heart-lung registrations varies widely by region.* Percent = # Lungs transplanted / donors*2
10 Evaluation of National Kidney Allocation Policy after the Elimination ofHLA-B Matching Points
11 BackgroundOn May 7, 2003, the kidney allocation system was modified so that:No points for HLA-B matches2 points for zero HLA-DR mismatches1 point for one HLA-DR mismatches.Previously:7 points for zero HLA-BDR mismatch5 points for one HLA-BDR mismatch
12 Data/MethodsDeceased donor kidney alone transplants performed at 35 DSA’s (with standard HLA points) between 5/7/02 and 5/6/04 were included.Pediatric recipients and recipients of expanded criteria donor (ECD) kidneys were excluded from the analysis.Out of the 58 DSA’s, only 35 use the standard HLA point system. The remaining DSA’s modify the points in some fashion or another.Of the 35 with standard HLA points, only 18 use the national system – the others have some sort of other variance or ALU.
13 Data/MethodsCompare percentage of transplants by ethnicity, HLA MM level, PRA, wait time, and graft survival in two periods:Pre-policy period: 5/7/02-5/6/03N = 3,236Post-policy period: 5/7/03-5/6/04N = 3,001
14 Non-Zero MM Transplants by Policy Period and Ethnicity
15 Non-Zero MM Transplants by Policy Period and HLA DR MM
16 Non-Zero MM Transplants by Policy Period and HLA MM
17 Non-Zero MM Transplants by Policy Period and Peak PRA (%)
18 Non-Zero MM Transplants by Policy Period and Wait Time
20 Summary Compared with pre-policy period: More minority candidates received a non-zero MM kidney transplant.More transplants with worse HLA DR MM.More transplants with PRA > 80%.More transplants with longer waiting times.Graft survival rates were similar.
21 Evaluation of National Liver Allocation Policy after the Implementation of Share 15 Policy
22 BackgroundOn January 12, 2005, the liver allocation system was modified:Local – Status 1A, Status 1BRegional – Status 1A, Status 1BLocal – MELD/PELD > 15Regional – MELD/PELD > 15Local – MELD/PELD < 15Regional – MELD/PELD < 15National – Status 1A, Status 1B, MELD/PELDPreviously:Local – MELD/PELDRegional – MELD/PELD
25 Adults Removed for Death/Too Sick from Liver Waiting List Pre-Policy Period: 1/12/04 – 5/11/04
26 Adults Removed for Death/Too Sick from Liver Waiting List Post-Policy Period: 1/12/05 – 5/11/05
27 Death Rates per 1000 Patient Days Liver Candidates on the Waiting List During 9/12/04 - 5/11/05 By Age at Listing and Policy Period
28 Organs Transplanted Locally vs. Non-Locally What percentage of organs are transplanted outside the DSA?Some are offered and refused locally, but are ultimately transplanted outside the DSAOthers are offered outside the DSA first (no local patients, Status 1 liver shares, 0MM kidneys, Statewide shares, etc.)How well do these organs function?UNetsm Utility for Recovering OPOsOverall survival rates shown here (adult donors, excluding repeat txs and multiorgan txs)
29 Kidney Transplants from Adult Donors by Region of Recovery 2003 - 2004
30 Kidney Transplants from Adult Donors by Region of Recovery 2003 - 2004
31 Kidney Transplants from Adult Donors by Region of Recovery 2003 - 2004
45 HHS PART Goals Performance Assessment and Review Tool (PART) 10 year and annual programmatic goalsIncrease donors, transplants, life years gained for kidney tx, reduce costs per txVery aggressive annual goals
46 Monthly National Donation Rates CollaborativeStarts Here
47 HRSA’S PART GoalsIncrease the number of deceased donor organs transplantedIncrease the number of non-DCD donorsIncrease the number of DCD donorsIncrease the average number of organs transplanted per non-DCD donorIncrease the average number of organs transplanted per DCD donors
48 HRSA’s PART GOALSIncrease the number of deceased donor organs transplanted each year until 42,800 are transplanted in 2013Organs Txed
49 HRSA’s PART GOALS # Non-DCD Increase the number of non-DCD donors each year until 9251 is achieved in 2013# Non-DCD
50 HRSA’s PART GOALSIncrease the number of DCD donors each year until 2018 is achieved in 2013
51 HRSA’s PART GOALSIncrease the average number of organs transplanted per non-DCD donors each year by to reach 4.0 in 2013Avg. Tx/Donor
52 HRSA’s PART GOALSIncrease the average number of organs transplanted per DCD donors each year by to reach 3.0 in 2013Avg. Tx/Donor
53 HRSA’s PART GOALSIncrease the total expected life-years gained for kidney transplant recipients in the first 5 years after transplant compared to what would be expected had they remained on the waiting list
54 HRSA’s PART GOALSIncrease the average number of years of life gained in the first 5 years after the transplant for deceased kidney/kidney-pancreas transplanted by life-years until the goal of life-years gained per transplant is achieved in 2013
55 Transplants from DCD Donors July, 2004 – June, 2005