1. 1 OPTN/UNOS Histocompatibility Committee Fall 2015

2. 2 Current Public Comment Proposals  Reminder: Proposal to Update the HLA Equivalency Tables currently out for public comment  Updates to HLA matching equivalences and HLA unacceptable antigen equivalences  Adds most common alleles to HLA antigen dropdowns in UNet SM  Update labels for some loci (DPB  DPB1; DQA  DQA1; DQB  DQB1)  On non-discussion agenda, submit your comment via OPTN website: http://optn.transplant.hrsa.gov/governance/public- comment/http://optn.transplant.hrsa.gov/governance/public- comment/  Planned Board presentation: December 2015

3. 3 Upcoming Policy and System Changes All 3 implemented by early Q1 of 2016: 1. Expanding candidate and deceased donor HLA typing requirements 2. Label change for HLA-Cw and HLA-DQ in UNet 3. Kidney Paired Donation histocompatibility policies

4.  DonorNet ®  Adds DQA1 and DPB1 as required fields to make kidney, kidney-pancreas, and pancreas offers  Waitlist SM  Adds DQA1 and DPB1 to unacceptable antigens section and import functionality  Makes A, B, Bw4, Bw6 and DR required for pancreas islets candidates  Other changes  DPB1 values 2 and 4 will be replaced with 02:01, 02:02, 04:01 and 04:02  Additional HLA required if requested for:  Liver: A, B, Bw4, Bw6, C, DR, DR51, DR52, DR53, DQA1, DQB1, and DPB1  Heart and Lung: DQA1 and DPB1 1. Expanding Candidate and Deceased Donor HLA Typing Requirements - Changes 4

5.  HLA-Cw re-labeled to HLA-C  HLA-DQ re-labeled to HLA-DQB1 2. Label Change for HLA-Cw and HLA-DQ in UNet 5

6.  Only applicable to OPTN KPD Pilot Program  For Donors:  Must report full list of HLA types on KPD donors  Molecular HLA typing required for donors  For Candidates:  If candidate has unacceptable antigens, you must report corresponding HLA type  Molecular HLA typing required  Candidate’s hospital must retype donor to confirm HLA type  Work with your lab if donor or candidate has incomplete HLA 3. Kidney Paired Donation Histocompatibility Policies 6

7.  Candidate’s transplant hospital must screen all KPD candidates for antibodies:  every 90 days (+/- 20 days)  when potentially sensitizing event occurs  if candidate reactivated after more than 90 inactive days  if unacceptable positive crossmatch occurs that prevents transplant with matched donor 3. Kidney Paired Donation Histocompatibility Policies 7

8.  Crossmatch  Candidate’s transplant hospital must perform physical crossmatch and report results:  Before donor’s nephrectomy is scheduled  After final crossmatch before the transplant  If match offer is declined due to unacceptable positive crossmatch candidate will be ineligible for subsequent match runs until transplant program confirms it has reviewed candidate’s UAs 3. Kidney Paired Donation Histocompatibility Policies 8

9. Dolly Tyan, Ph.D. Committee Chair dtyan@stanford.edu Regional representative name (RA will complete) Region X Representative email address Geoff Zindren Committee Liaison Geoffrey.Zindren@unos.org Questions? 9