Guidance on Optimizing VCA Recovery from Deceased Donors Vascularized Composite Allograft (VCA) Transplantation Committee

What problem will the proposal solve? VCA transplant candidates present specific matching needs Need to identify more potential deceased VCA donors Address an education gap with OPO personnel VCA transplant candidates have unique and specific matching needs with deceased organ donors. This goes beyond blood type and histocompatibility matching to include skin color, hair color and thickness, anatomical dimensions, vascular quality, and the presence of distinguishing marks like scars or tattoos. Other donor factors, such as complex medical-social history, or designation as a PHS increased risk donor add matching challenges for VCA transplantation. With these specific matching requirements and the low numbers of VCA donors currently recovered, the VCA Committee has determined that OPOs need to identify more potential deceased VCA donors. Also, this guidance addresses an education gap identified in the OPO community regarding VCA authorization and recovery.

What are the proposed solutions? Guidance to optimize VCA authorization and recovery by sharing effective practices Collaboration with experienced OPOs in the U.S. Reinforce that OPOs can support VCA transplant programs nationwide The VCA Committee has developed guidance to optimize VCA authorization and recovery in collaboration with OPOs in the U.S. with VCA recovery experience. As a result of this guidance, OPOs without experience in VCA recovery will have access to effective practices identified by those OPOs with experience in the field. This guidance reinforces the concept that OPOs can support VCA transplant programs nationwide.

What are the proposed solutions? Guidance on: Decision to participate in VCA recovery Planning and hospital partnerships Accessing the VCA candidate list Family support and approach VCA donor evaluation Recovery & post-recovery considerations Considerations for communications & public relations The Committee feels this guidance addresses an unmet need for the OPO community and was created with the flow of a donor case in mind. The under laying themes throughout this document are the need for OPOs to partner with VCA programs well before considering any deceased donors for VCA recovery, and frequent and diligent communication between the host OPO, solid organ teams, and the VCA program during the family approach, donor management, and perioperative time periods. Topics covered in the guidance include: Decision to participate in VCA recovery Planning and hospital partnerships Accessing the VCA candidate list Family support and approach VCA donor evaluation Recovery & post-recovery considerations Considerations for communications & public relations

How will members implement this proposal? Guidance will provide OPOs with information to address potential barriers to VCA authorization and recovery May be used to develop SOPs/protocols for VCA recovery This guidance is an optional resource for OPO leaders and their staff. It is intended to help OPOs overcome barriers to VCA authorization and recovery by sharing effective practices, and the understanding that VCA programs do not need to be within the same DSA as the OPO in order to successfully recover VCAs for transplant. OPOs are encouraged to use this document to develop internal SOPs/protocols for VCA recovery.

How will the OPTN implement this proposal? Board consideration – June 2018 No programming in UNet Members will not be evaluated for compliance with this document The target date for Board consideration is June 2018. If approved, the document will be available on the OPTN website shortly thereafter. Training materials associated with this guidance will be coordinated in UNOS Connect with announcements on TransplantPro. There is no programming associated with guidance documents in any OPTN systems. It should be noted that guidance from the OPTN is intended to support the organ donation and transplantation fields. Guidance does not carry the weight of policies or bylaws and you will not be evaluated for compliance with this document.

Questions? L. Scott Levin, M.D., FACS Committee Chair scott.levin@uphs.upenn.edu Linda C. Cendales, M.D. Committee Vice Chair linda.cendales@duke.edu Christopher L. Wholley, M.S.A. Committee Liaison christopher.wholley@unos.org