Guidance on Requested Deceased Donor Information OPO Committee

What problem will the proposal solve? Change initiated during review of Policy 2: Deceased Donor Information Address concerns with eliminating Policy 2.12: Requested Deceased Donor Information Contains requested information for kidney, heart, and lung The changes to Policy 2.12: Requested Deceased Donor Information were made during the policy review by the System Optimizations Work Group. The group decided that the policy should be eliminated since the information was not required, although there was some concerns raised about the information no longer being available as a reference. The Board of Directors voted to eliminate this policy during its December 2017 meeting and the change will go into effect on March 1, 2018. The purpose of this guidance document is to address those concerns and provide members with a resource that outlines some of the common requested information. The current policy only contains requested information for kidney, heart, and lung. For kidney – the requested information addresses the biopsy information for high KDPI donors (greater than 85%) For heart – the requested information addresses additional testing such as coronary angiography, central venous pressure or Swan Ganz, cardiology consult and cardiac enzymes. It also the criteria for requesting a heart catheterization. For lung – the requested information addresses chest measurements, mycology sputum smear, and CT scan of the chest.

What are the proposed solutions? Develop guidance document Include and update donor information previously located in Policy 2.12 Add new information for liver and pancreas The OPO Committee agreed that while the requested information should not be included in policy, it should be available to OPOs and transplant hospitals if needed. The guidance document includes an updated version of the deceased donor information being removed from Policy 2.12: Requested Deceased Donor Information as well as new information for liver and pancreas donors.

What are the proposed solutions? Kidney information – removed wedge biopsy requirements and added recommendation for machine perfusion information Liver – includes liver biopsy information and CT scan recommendation Heart – updated information for additional testing and heart catheterization Lung – Added indications for CT scan and recommendations for bronchoscopy and other tests Pancreas – recommended images of organ This slide outlines some of the changes to the requested information. Kidney information – removed wedge biopsy recommendations since the biopsy sample can be obtained by method of choice. Added recommendation for machine perfusion information such as the pump parameters (e.g. flow and resistance). Liver information – this includes liver biopsy information (indications and contraindications) and a recommendation for a CT scan if the liver is being considered for a split. Heart information – this has updated information for additional testing (stroke volume variation, transesophageal echocardiography), added troponin and serum creatinine kinase MB to the cardiac enzyme panel, and updated the heart catheterization section. Lung Information – we added indications for CT scan and recommendations for bronchoscopy and other tests such as an echo or Swan Ganz if suspected pulmonary hypertension in the donor. Pancreas information – the only thing recommendation added for pancreas donors is for images of organ – there is a recommendation for images included for all the organ types.

How will members implement this proposal? Voluntary guidance only OPOs and transplant hospitals could use this guidance to identify information to assist with the evaluation of organ offer This guidance does not require any member action and it would be for voluntary use, if approved.

How will the OPTN implement this proposal? Board review date: June 2018 Post on the OPTN website No policy compliance requirements This guidance document would be reviewed by the Board of Directors in June 2018. If approved by the Board of Directors you’ll be able to access this document on the OPTN website.

Questions? Jennifer Prinz, RN, BSN, MPH, CPTC Committee Chair jprinz@donoralliance.org Robert Hunter Committee Liaison robert.hunter@unos.org