1. The Impact of the Kidney Allocation System Marlene Abe, Transplant Coordinator UCI Medical Center – Orange, California Jim Trisch, Manager – Clinical Services St. Vincent Medical Center- Los Angeles, California Region 5’s Transplant Center Experience

2. Transplant Center Poll 11 8 6 5 73% 83% *Please Note: Poll Did Not include Pediatric Centers Total Reponses: 76%

3. 3 Survey Questions Transplant Center Poll What 2 challenges have you encountered since the implementation of KAS? What 2 successes have you encountered since the implementation of KAS? What 2 changes you have made as a result of the new KAS? Additional Comments?

4. Question #1 What challenges have you encountered since the implementation of KAS? Responses: –(53%) Prior “Top listed” pts. were ready to go for tx. New top list “CPRA group”, some of these pts. are not ready to go. Not mentally prepared - anticipated waiting longer Pts. have not been recently seen by the team, do not have current sera, not financially cleared or insurance has changed Pt. understanding of the new KAS - more pt. education needed, confusing and difficult for pts. to understand.

5. Question #1 What challenges have you encountered since the implementation of KAS? Responses: –(47%) Long distance OPOs refusing to send blood to facilitate cross match on high PRA pts. Unable to do cross match prior to OR, demanding the tx ctr. does a virtual cross match first, which delays the process and increases the CIT. Possible manipulation of the system? –(12%) Kidneys from local donors use to stay locally, now most of those kidneys go outside the DSA to other centers.

6. Question #1 What challenges have you encountered since the implementation of KAS? Responses: –(1%) Increase volume of “ Top Listed” patients on waitlist –(1%) 98-100% Highly Sensitized patients coming up quicker than anticipated. –(1%) Scoring of pediatric en-bloc is not appropriate Falling in the KDPI >85% requiring consent –(1%) Kidney’s are coming in for high PRA with no local back-up (back up not allowed for highly sensitized patients), therefore kidneys are being sent back

7. Question #2 What changes you have made as a results of the new KAS? Responses: –(100%) Implementation of a new KDPI Consent –(24%) Created an additional top listed pt. list to ensure these pts. are ready for tx (blood group & CPRA) –(24%) Education – staff, physicians, and patients –(5%) Increased age limit for organ acceptance which increased organ offers –(1 %) Review new “ Top Listed” to be financially cleared. –(1%) Look at MFI for all patients with high CPRA’s

8. Question #3 What successes you have encountered since the implementation of KAS? Responses: –(53%) More kidney offers, highly sensitized patients that never received an offer before are now receiving multiple offers and are getting transplanted quicker. More Transplants !! –(18%)Younger pt’s are coming up on the match run, offered better kidneys, offered younger kidneys –(18%) No benefits or success at this time

9. Additional Comments Overall tx volume decreased (not sure if it is because of the new KAS) Pediatric & K/P pts. - not receiving as many offers (majority of good kidneys going to the highly sensitized pts.) = longer wait time Concerns: non-compliant pts. loose their kidneys & become highly sensitized, now being given priority & transplanted before other compliant pts., pediatric or K/P pts. Still learning – virtual cross match when offered highly sensitized pts Hopeful that the KAS will bring more equitability Happy to see that paybacks are a “thing of the past”

10. The Impact of the Kidney Allocation System OPO Report Out - Region 5’s Survey Results Sara Bowman, Intermountain Donor Services Aaron Cohen, OneLegacy

11. 3 Survey Questions OPO Poll What 2 challenges have you encountered since the implementation of KAS? What 2 successes have you encountered since the implementation of KAS? What 2 changes you have made as a result of the new KAS? Additional Comments?

12. Question #1 What challenges have you encountered since the implementation of KAS? Increase in import offers and imports Learning the logistics and gray areas between the KAS, PAS and Liver allocation Logistics of orchestrating prospective x- matches with high CPRA candidates Increased HLA laboratory demands for typing

13. Question #2 What changes you have made as a results of the new KAS? Biopsy criteria now considers KDPI instead of ECD No longer tracking paybacks Tracking more data (learned from our Share 35 experience) Crossmatch Process Changes Local Back-up Procedures

14. Question #3 What successes you have encountered since the implementation of KAS? Intended Receipents are being transplanted Increased oppurtunities for staff education and optimazating of process Increased number of high CPRA candidates being transplanted Increased interaction with local and regional transplant programs Increased awareness of local center acceptance practice Increased attention to how we can optimize placing

15. Discussion Questions: Provide 2 challenges you have faced since the implementation of KAS? Provide 2 changes you have implemented since the implementation of KAS? Provide 2 success since the implementation of KAS?