Improving the Efficiency of Organ Placement Organ Procurement Organization Committee

What problem will the proposal solve? Inefficiencies in the current placement system Current response time limits are too long No current time limit for making a final decision Current policy allows multiple centers to accept multiple offers for the same candidate No OPO requirement to enter organ acceptance in a specific timeframe Inconsistencies and redundancies in Policy 2.11 The purpose of this proposal is to improve the placement of organs. Usable organs are sometimes discarded due to inefficiencies in the current system. As we move forward with proposals to increase the broader sharing of organs, members have expressed concerns that larger geographic districts could exacerbate any inefficiencies in the current system. Some of the inefficiencies identified include: The current time limits of one hour to acknowledge an offer with an additional hour to evaluate the offer are too long. No current policy requirement limiting how long a primary center can take to make a final decision on an organ offer. Multiple offer acceptances for the same organ for one candidate OPOs are not currently required to enter organ acceptances on the match run in a specific timeframe   The Committee also identified some inconsistencies, redundancies, and outdated language in Policy 2.11.

What are the proposed solutions? Reduce current time limits for responding to organ offers: Initial offer to acknowledgement: 30 minutes Acknowledgement to response: 30 minutes Establish new time limit for primary transplant hospitals to make a final decision on organ offers (1 hr.) Limit simultaneous organ acceptances per candidate to 2 Require OPOs to enter organ acceptance when received Modify Policy 2.11: Deceased Donor Information This proposal is the first step to improve organ placement by: reducing the current time limits for responding to organ offers from 1 hour to 30 minutes. Review of data showed that the responses are received within 30 minutes of initial notifications and evaluation across all organs in 90% of cases. establishing a new time limit of 1 hour for the primary transplant hospitals to make a final decision on organ offers – this time limit will begin when the OPO notifies the transplant hospital that their candidate is now the primary offer AND that all the required deceased donor information is available. The proposed policy makes it permissible for OPOs to offer the organ to the next candidate on the match run. limiting the number of simultaneous organ acceptances for each candidate to 2 – this is actual acceptances, not provisional yes acceptances requiring OPOs to enter the organ acceptances on the match run as they are received – again this is indicating “organ placed” in DonorNet, not provisional yes acceptances. The Committee is also proposing some changes to Policy 2.11: Required Deceased Donor Information This policy has been in place for a long time and contains a list of lab tests and other information The System Opts work group has worked hard to streamline this policy by simplifying the language and getting rid of redundancies and outdated requirements There is also a fair amount of language that is more operational such as documenting when certain tests like a bronchoscopy can’t be performed. And finally, the list of “requested donor information” has been removed from policy since these are not requirements. The work group will be developing a guidance document to further address deceased donor information. Finally, we have created definitions for organ offer acceptance, organ offer refusal, and provisional yes

How will members implement this proposal? Transplant Hospitals will need to: Evaluate processes in consideration of reduced time limits Primary centers must make a final decision within one hour Have only two simultaneous organ offer acceptances per candidate for each organ type This proposal will require transplant hospitals to evaluate their processes for receiving organ offers. The reduction in time limits could impact those organizations that currently use third-party vendors to receive organ offers. Transplant hospitals also need to be aware of the new proposed one hour limit for making a final decision once the OPO notifies them that their candidate is the primary offer and all the required deceased donor information is available. Finally, transplant hospitals need to be aware that only two organ offer acceptances will be allowed for one candidate (for the same organ).

How will members implement this proposal? OPOs will need to: Enter organ offer acceptances immediately Review changes to Policy 2.11: Required Deceased Donor Information No additional data collection will be required This proposal will require OPOs to indicate organ offer acceptances in DonorNet in real time to ensure that the proposed organ offer acceptance limit meets its intended goal. OPOs should also review the changes to Policy 2.11: Required Deceased Donor Information in order to ensure timely and accurate reporting of donor information. This proposal does not require additional data collection by transplant hospitals or OPOs.

How will the OPTN implement this proposal? Anticipated Board of Directors Review: Dec. 2017 Required Programming: Modify current automated notifications Create notification limits for organ offer acceptance If public comment is favorable, the Committee plans to bring this guidance to the Board of Directors in December 2017. As these policy changes affect receiving and accepting organ offers, an educational program addressing the member impact will be developed.   This proposal will require programming in UNetSM. For reducing the time limits to respond to organ offer from 1 hour/1 hour to 30 min/30 min, the automated notifications that currently go out at 20 mins and 30 mins will need to be modified to 10 mins and 20 mins. For the limit on the number of organ offer acceptances, the system will notify OPOs and transplant centers that an acceptance limit has been reached and provide them with the ability to turn down one of the previous two acceptances.

Questions? Jennifer Prinz, RN, BSN, MPH, CPTC Committee Chair jprinz@donoralliance.org Robert Hunter Committee Liaison robert.hunter@unos.org