System Optimizations Work Group Update Region 2 Meeting March 17, 2017

Time Limit for Final Decision The work group has discussed creating an additional time limit for a “final decision” for primary and backup centers (no current requirements) – concerns about the availability of information Required Donor Information The work group has finalized the list of required donor information Most of the information is located across different policies So during our most recent meetings we have come to an agreement on a couple of things: Time Limit for Final Decision The work group has been discussing an additional time limit of 1 hour for the primary and backup centers to make a “final decision” so OPOs can schedule organ recoveries (no current requirements) - One of the concerns with doing this, from the transplant center side, is the availability of important donor information in order to make a decision. Required Donor Information The work group has been working on a list of required information that needs to be provided by the OPO before the “clock starts.” The work group finalized the list during its meeting in February. For the most part the information is already in various locations within policy or required as a DonorNet field. We just want to make sure there was agreement on the information and have it located in one section of policy. So we are working on changing policy language.

Organ Offers Accepted for One Candidate Issue with the number of organ offers some transplant hospitals are accepting for one candidate Leads to late declines/reallocation/logistical issues Recommend a limit of two organ acceptances for one candidate The other issue we discussed during the last two meetings was limiting the number of offers that can be accepted for one candidate. Anecdotally, there have been concerns raised about how some centers are accepting multiple offers for one candidate. This can lead to late declines, reallocation, and logistical issues for OPOs. The work group recommended a limit of two organ acceptances for one candidate.

Organ Acceptances There were several options provided to the work group 1) Limit of two acceptances (provisional and match run) for all candidates 2) Limit of two acceptances (provisional and match run) for the primary and backup centers 3) Limit of two match run acceptances for the primary center (3a – limit of two acceptances – provisional and/or match run) 4) Policy language stating that a center can only accept two organs for the same candidate and add feature to the match run page that allows OPOs to see all offers for candidates There were several options provided to the work group. The issue with all of these is that the practice of managing the match runs in real time is not uniform. In fact Policy 18.1 (Data Submission) allows the allocating OPOs up to 30 days after the match run date to submit PTR data.

Organ Acceptances - Recommendations Limit of two match run acceptances for one candidate Require OPOs to manage the match run acceptances in real time. The work group recommended a limit of two match run acceptances for one candidate, this is the green check in DonorNet that indicates “organ placed.” The work group also recommended requiring OPOs to manage the match run acceptances in more real time. OPO reps on the work group supported this, especially considering the benefit of managing this in real-time. There is an opportunity to change practice, particularly for liver allocation when there is an opportunity for more offers to candidates at the top of the list.

Next Step Draft policy language for the next public comment period Reduce the current time limits for responding to electronic organ offers from 1 hr/1 hr to 30 min/30 min Add additional time limit of 1 hour to make a final decision once all required information has been provided Limit the number of offers that can be accepted for one candidate Requirement OPOs to manage match run acceptances in real time Revise or create definitions The next step is to draft policy language for the next public comment period. The changes will include the following: Reduce the current time limits for responding to electronic organ offers from 1 hr/1 hr to 30 min/30 min Add additional time limit of 1 hour to make a final decision once all required information has been provided Limit the number of offers that can be accepted for one candidate Requirement OPOs to manage match run acceptances in real time Revise or create definitions - For example, define organ acceptance, backup offer, etc.

Additional Issues DonorNet changes to provide automated notifications Increasing the number of simultaneous offers Evaluate transplant center acceptance criteria and acceptance practices The work group has recommended a list of DonorNet changes that will help make the organ allocation process more efficient. This includes automated notifications when donor information is added or modified, when a center becomes primary or backup, and updates to certain functionalities in DonorNet. These changes are being evaluated and prioritized internally by the UNOS Customer Innovations group. Increasing the number of simultaneous offers – this issue is being addressed as part of the expedited placement project which is just getting started. Another issue the work group identified as a barrier to efficient organ allocation is transplant center acceptance criteria and acceptance practices. The work group will begin to discuss these in the coming months.

Questions?