Thoracic Organ Transplantation Committee Fall 2017

Policy Implementation Dates Modify Adult Heart Allocation System Two phases: Release 1: Waitlist changes Release 2 – DonorNetSM changes Gap of 30 days between both releases Full implementation estimated Q1 2018, but under review The proposal to modify the adult heart allocation system went out for two rounds of public comment in 2016. The OPTN Board of Directors approved the proposal during their December meeting. This proposal suggested that we modify the adult heart allocation system to better stratify the most medically urgent heart transplant candidates, reflect the increased use of mechanical circulatory support devices (MCSD) and increased prevalence of MCSD complications, and address geographic disparities in access to donors among heart transplant candidates. Implementation is contingent on IT programming and notification to members and will occur in two phases. Phase 1 will entail changes to Waitlist to allow transplant programs to submit new justification forms. Phase 2 will encompass changes to DonorNet and the new heart allocation algorithm will be fully implemented. There will be 30 days between the two releases to allow programs to bring patients in for any necessary testing before submitting the relevant justification forms. On the date the new changes go live, candidates will be assigned to the new statuses.

Modification to the Adult Heart Allocation System Planned Educational Offerings: 2017 October: Policy training 2018 January: Transition training February: How to talk to patients & System training March: RRB training April: OPO training As part of the implementation efforts, the Committee is developing a robust educational program for the community, including offerings tailored to transplant programs, OPOs and review boards. The first module will be offered in October and will provide an overview of the policy changes. We will offer additional training over subsequent months, into 2018. Watch for additional information and exact dates.

Committee Projects Heart: Lung: Regional Review Board Guidance for: Adult Congenital Heart Disease Exception Requests – out for public comment now Hypertrophic and Restrictive Cardiomyopathy Exception Requests – future public comment cycle Lung: Modify Lung Transplant Follow-up Form to Include CLAD Data Refine and Clean-up LAS This is a summary of other projects the Committee is currently working on. The Committee currently has a proposal out for public comment, “Regional Review Board Guidance for Adult Congenital Heart Disease Exception Requests”. This proposal is on the non-discussion consent agenda, but I encourage my thoracic colleagues to review it and post your feedback on the OPTN website. This guidance, along with guidance for hypertrophic and restrictive cardiomyopathy exception requests, currently under development, were undertaken to address specific concerns we heard from the community during both rounds of public comment for the heart proposal. We are also taking on a project to modify data collection to the “Graft Function” section of the lung transplant follow-up forms. Finally, as with other major allocation system projects, we seek to explain LAS post-implementation data trends as well as a number of clarifications to lung allocation policy that generated questions from the community.

Questions? Kevin Chan, MD Committee Chair kevichan@med.umich.edu Kimberly Uccellini, MS, MPH Committee Liaison Kimberly.Uccellini@unos.org