OPTN Minority Affairs Committee Update March 13, 2012 Meeting Chicago O’Hare Hilton

OPTN Minority Affairs Committee Update  Educational Guidelines on Patient Referral to Kidney Transplantation  Disparities in Presentation of Transplant Information  Ongoing CPRA Analysis  Update on New Proposed MAC Projects

OPTN Educational Guidelines on Patient Referral to Kidney Transplantation MAC Subcommittee formed to develop educational guidelines for providers regarding appropriate patient referral. Draft guidelines document has been approved by the Subcommittee and full Committee. Additional review by Kidney, Patient Affairs, Living Donor and Transplant Administrators Committee as well as professional transplant partner s (NKF, AST, ASTS, KDOQUI, AMAT, NTSW, etc.) will occur as part of an expanded Subcommittee.

OPTN Disparities in Provision of Transplant Information  Many patients uninformed of kidney transplant options at time of 2728 filing.  Most common reason reported: patient not assessed at filing time.  Factors influencing likelihood of referral: profit/non profit status of dialysis center age, gender, ethnicity obesity insurance status (private vs. public) under the care of a nephrologist prior to ESRD

OPTN Evaluation of Calculated PRA (CPRA) Policy for Allocation of Deceased Donor Kidneys: Transplant Rates by Ethnicity and Sensitization Level

OPTN Adult Kidney Registrations as of 2/10/12 38% White, 34% Black, 18% Hispanic, 7% Asian and 2% other ethnicities. 38% White, 34% Black, 18% Hispanic, 7% Asian and 2% other ethnicities. 16% -- CPRA value of %. 16% -- CPRA value of %. 9.8% waiting with current CPRA ≥ 98%, and of these, 43% were Black, 35% White, 14% Hispanic, 6% Asian, and 2% other ethnicities. 9.8% waiting with current CPRA ≥ 98%, and of these, 43% were Black, 35% White, 14% Hispanic, 6% Asian, and 2% other ethnicities.

OPTN TX Rate Changes Post Policy Implementation Significant decrease for non-sensitized (CPRA 0%) and low sensitized CPRA 1-20%) White, Black, and Hispanic candidates Significant decrease for non-sensitized (CPRA 0%) and low sensitized CPRA 1-20%) White, Black, and Hispanic candidates Significant increase for White, Black, and Asian moderately sensitized (CPRA 21-79%) candidates Significant increase for White, Black, and Asian moderately sensitized (CPRA 21-79%) candidates No significant change among American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, or Multiracial candidates, regardless of sensitization level. No significant change among American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, or Multiracial candidates, regardless of sensitization level.

OPTN Changes in TX Rates Significant increase for highly sensitized (CPRA %) White, Black, and Hispanic candidates Significant increase for highly sensitized (CPRA %) White, Black, and Hispanic candidates Significant increase among White, Black, and Hispanic candidates with a CPRA of 80-97%, but decrease (although not significant) in transplant rates for those with CPRA of %. Significant increase among White, Black, and Hispanic candidates with a CPRA of 80-97%, but decrease (although not significant) in transplant rates for those with CPRA of %. This was also true for Asian candidates, although the decrease in transplant rates for those candidates with CPRA ≥ 98% was significant. This was also true for Asian candidates, although the decrease in transplant rates for those candidates with CPRA ≥ 98% was significant.

OPTN Eligible Donor Conversion Rates By Region and Ethnicity

OPTN Eligible Donor Conversion Rates, 2/1/08-11/30/11 by Year: All Regions 10

OPTN Eligible Donor Conversion Rates, 2/1/08-11/30/11 by Donor Ethnicity: All Regions 11

OPTN Eligible Donor Conversion Rates, 2/1/08-11/30/11 by Year and Ethnicity: All Regions 12

OPTNResults  Across all regions and donor ethnicities the donor conversion rate was 70.1% and it ranged from 67% in 2008 to 73% in  Overall conversion rate was the highest among donors of multiracial ethnicity (85%), followed by White donors (78%), Hispanics (67%), Blacks (55%), Asians (48%), Native Hawaiians/other Pacific Islanders (46%), and American Indians/Alaska Natives (40%).

OPTNResults  Within each region, eligible donor conversion rates varied among donor ethnic groups.  Regions 4 and 6 seemed to have increasing conversion rates across different donor ethnic groups during

OPTN Update on New Proposed Committee Projects  Referral Survey to Assess Barriers to Thoracic Transplantation  Minority Donor Conversion Rates