Guidance for ABO Subtyping Organ Donors for Blood Groups A and AB Hello Everyone, my name is ____________ from [name of organization]. Today, I’ll be presenting the revised “Guidance for ABO Subtyping Organ Donors for Blood Groups A and AB” proposal put forward by the Operations and Safety Committee. OPTN/UNOS Operations and Safety Committee

What problem will the proposal solve? Update guidance to keep it relevant and timely Address need and questions raised within transplant community Address issues observed in site survey The Board of Directors originally approved “Guidance for ABO Subtyping Organ Donors for Blood Groups A and AB in June 2011. We need to make sure the available information is still relevant and up to date. We know that there have been policy changes since 2011. The current guidance still references kidney variance policies which no longer exist. The Committee has revised the guidance to address these issues and can provide an up to date resource that can be used to guide subtyping practices. We know the guidance is still relevant because when we rewrote ABO policies several years ago we found that many in the community still had subtyping questions. We also know that site surveyors have found a number of issues during recent OPO review cycles.

What are the proposed solutions? Guidance revisions: Updated OPTN Policy references Amended information concerning special considerations Updated additional complementary resources Revised structure and addition of key points Made plain language edits   Most of the guidance has not changed in terms of content. But we propose changing the following: 1.) We have updated OPTN policy references. We have several policies in kidney, kidney-paired donation, and liver that use subtyping for allocation. These references are included. 2.) We also know that the community has questions about certain considerations that can impact subtyping accuracy. They want to know what time frame is used to define a pre-red blood cell transfusion, and when neonates can be subtyped. Neonates do not fully express red blood cell antigens at birth. We do not provide specific time frames on these but we do encourage all programs, both OPOs and transplant hospitals, to develop relationships with their blood banks as these professionals are the experts for these types of questions. Some OPOs have worked with their labs to develop consistent local practices. When an OPO determines that subtyping cannot be done accurately then it must be documented. We have also added information on common issues observed by site survey. 3.) We also point out complementary resources that did not exist in 2011. UNOSConnect contains two learning modules for ABO including subtyping as well as one specifically devoted to subtyping. The OPTN/UNOS Board of Directors also recently approved guidance that is now published to increase use of non-A1 and non-A1B kidneys. Together these resources can help programs and we want to make sure our guidance complements the other available resources. 4.) We also reorganized the guidance to include an up front summary of key points for those who just want a quick reference. 5) Finally, we used more plain language to make it easier to understand.

How will members implement this proposal? Transplant Hospitals and OPOs Using guidance is voluntary May be helpful for staff training and questions Guidance is not the same as a policy requirement. Use of the guidance for training and to educate staff is encouraged but not mandated.

Specific Feedback Is guidance sufficient for special considerations (red blood cell transfusions, neonates)? Do you need more detail or policy? Did we fail to address any other concerns? We do want to know if the guidance provides enough direction on issues such as pre-red blood cell transfusion specimens and neonates. We also want to know if there are other concerns that the guidance should include.

How will the OPTN implement this proposal? Anticipated Board Review date: June 11-12, 2018 Anticipated Implementation date: June 15, 2018 No programming in UNet No policy compliance requirements Current guidance is available here under “Other” Updated guidance, if approved, will be posted on this site. We anticipate that this guidance will be considered at the June Board of Directors meeting. If approved, the guidance will be effective once posted on the OPTN website.

Questions? David Marshman, CPTC Operations and Safety Committee Chair David.Marshman@lifelinkfound.org Susan Tlusty Operations and Safety Committee Liaison Susan.tlusty@unos.org