Liver and Intestine Committee

Slides:



Advertisements
Similar presentations
SRTR Transplant Benefit-Based Liver Allocation Robert M. Merion, MD, FACS OPTN/UNOS Liver Forum Atlanta, GA April 12, 2010.
Advertisements

Kidney Transplantation Committee Spring Waiting time calculation - pre-registration dialysis time added 2.Candidate classification - Estimated.
Concentric Circle Liver Distribution Models
OPTN Session 3 OPTN Policy Development and Feedback from RFI / Highlights of concepts being explored April 12, 2010.
Liver and Intestinal Organ Transplantation Committee Spring 2014 Update.
UNOS Update.  Updating 2012 Strategic plan  Planning for OPTN and UNOS Strategic Planning RegionsBoard Executive Committee /CAC Community.
Proposal to Delay the HCC Exception Score Assignment (Resolution 9) Liver and Intestine Committee David Mulligan, Chair November 12 and 13, 2014.
Liver and Intestinal Organ Transplantation Committee Update Report David Mulligan, MD, Chair OPTN/UNOS Board of Directors Meeting November 12-13, 2014.
Proposal for Adolescent Classification Exception for Pediatric Lung Candidates Thoracic Organ Transplantation Committee Spring 2014.
OPTN Liver and Intestinal Organ Transplantation Committee Update Spring 2012 Kim Olthoff, MD, Chair David Mulligan, MD, Vice-chair.
OPTN Proposal to Revise the Lung Allocation Score (LAS) System and Salient Activities of the Thoracic Organ Transplantation Committee.
1 Proposal to Modify Pediatric Lung Allocation Policy Thoracic Organ Transplantation Committee Fall 2015.
Redesigning Liver Distribution David Mulligan, MD, Chair Liver & Intestinal Organ Transplantation Committee November 12-13, 2014.
Kidney Transplantation Committee Spring Waiting time calculation - pre-registration dialysis time added 2.Candidate classification - Estimated.
1 Simultaneous Liver-Kidney (SLK) Allocation Kidney Transplantation Committee Spring 2016.
Proposal to Establish a National Liver Review Board
Enhancing Liver Distribution
Liver and Intestinal Organ Transplantation Committee
Pediatric Transplantation Committee
National Liver Review Board (NLRB)
Pediatric Transplantation Committee
Updates on the New Adult Heart Allocation System
Liver and Intestinal Organ Transplantation Committee
Liver and Intestinal Organ Transplantation Committee
Modifications to the Distribution of Deceased Donor Lungs
OPO Committee Spring 2018.
Pediatric Transplantation Committee
Thoracic Organ Transplantation Committee
OPTN/UNOS Kidney Transplantation Committee
Thoracic Organ Transplantation Committee Spring 2014
Pediatric Transplantation Committee
Ad Hoc Geography Committee Update
Pediatric Transplantation Committee
Liver and Intestinal Organ Transplantation Committee Update Report
Changes to HCC Criteria for Auto Approval
OPTN/UNOS Thoracic Organ Transplantation Committee
Liver Transplant Data for Regional Meetings
Membership & Professional Standards Committee
Thoracic Organ Transplantation Committee Spring 2019
Liver and Intestinal Organ Transplantation Committee
Expedited Placement of Livers
Liver and Intestinal Organ Transplantation Committee
Liver and Intestinal Transplantation Committee
Liver and Intestinal Organ Transplantation Committee
Pediatric Transplantation Committee
Thoracic Organ Transplantation Committee
Redesigning Liver Distribution
Pediatric Transplantation Committee
Enhancing Liver Distribution
Liver and Intestinal Organ Transplantation Committee
Liver and Intestinal Organ Transplantation Committee
Proposal to Delay the HCC Exception Score Assignment
Liver and Intestinal Organ Transplantation Committee Spring 2014
Liver and Intestinal Organ Transplantation Committee
Liver and Intestinal Organ Transplantation Committee
Liver and Intestinal Organ Transplantation Committee
Thoracic Organ Transplantation Committee
Liver & Intestinal Organ Transplantation Committee
Living Donor Committee
MELD Exception Scores During NLRB Transition
Liver Transplant Data for Regional Meetings
Liver and Intestinal Organ Transplantation Committee
Proposal to Delay the HCC Exception Score Assignment
Pediatric Transplantation Committee Fall 2014
Proposal to Cap the HCC Exception Score at 34
Pediatric Transplantation Committee
Liver Transplant Data for Regional Meetings
Liver Transplantation and Organ Allocation in 2019
National Liver Review Board
Organ Allocation Update: Lung and Heart Region 5 Collaborative Las Vegas, Nevada August 21, 2019 Maryl Johnson, MD President, UNOS/OPTN Board of Directors.
Presentation transcript:

Liver and Intestine Committee Spring 2019

Recent Public Comment Proposal Eliminate Region and DSA from Liver and Intestine Allocation Acuity Circles Model approved by the Board Allocation to candidates based on medical urgency and proximity of the transplant hospital to the donor hospital Increased priority for pediatric candidates to receive offers from pediatric donors Increased weight on proximity for DCD and donors over 70 years old Board approved 12/3/2018

Acuity Circles Allocation - adult Large circle (500 nm) for status 1 Small circle (150 nm) for 37-40, medium circle (250nm) for 37-40, large circle (500nm) for 37-40 Small circle for 33-36, medium circle 33-36, large circle 33-36 Small circle for 29-32, medium circle for 29-32, large circle 29-32 Small circle for 15-28, medium circle for 15-28, large circle 15-28 Only share for larger circle if no accepts patient in smaller circle The goal is to prioritize the most efficient placement among candidates with similar need, and when there is greater need, allow candidates who are further away to have increased access. The new allocation will remove DSA and region from the allocation sequences and instead use circles around the donor hospital of 150, 250, and 500nm. The sickest patients, those at status 1A or 1B within the largest circle will get the highest priority. Then allocated to candidates with the highest MELD/PELD scores within 150, then 250, then 500 nm. Then slightly lower MELD/PELD in the same distances, and on down.

Acuity Circles Allocation - pediatric Large circle (500 nm) for pediatric 1A National pediatric 1A and under 12 (only for the donors under 12) Large circle for adult 1A Large circle for pediatric 1B Large circle for PELD Large circle for adolescent MELD National in the same order Then large circles and adult MELD followed by national adult MELD Livers from pediatric donors will be allocated to larger circles, and to pediatrics first. They will not be offered to adults (other than status 1A) until after they have been offered nationally to the pediatric candidates.

Acuity Circles Allocation – DCD/>70 Large circle (500 nm) for status 1 Small circle (150nm) for 15-40, medium circle (250nm) for 15-40, large circle (500nm) 15-40 For DCD donors and donors over 70, the allocation sequence is condensed, with livers offered all the way down to MELD 15 in the smaller circle before they are offered to the next largest circle, and so on.

Policy Implementation Dates Acuity Circles Expected implementation ~April 30 Training beginning in March Expected implementation is at least 3 months after NLRB, on April 30

National Liver Review Board 3 national specialty review boards Pediatrics Adult HCC Adult Other Diagnoses Exception scores tied to median MELD/PELD at transplant (MMaT/MPaT) MMaT within 250NM MPaT for the nation The NLRB implementation date will be after public comment. In 12/2017 the board approved a policy to create national liver review boards. This was updated as part of the proposal that was approved in 12/2018 to remove DSA and region from allocation. All of the pieces related to the NLRB in both proposals will be implemented together. 3 specialty review boards (Pediatric, adult HCC, and adult other diagnosis) members can appoint one representative and one alternate to each (only programs that do peds can appoint to ped board) Exception scores will be tied to MMaT. For MELD scores, it will be based on the median within 250nm of the listing program when redistribution is implemented ~ April 30. The MMaT to be used prior to full implementation is currently out for public comment, and is discussed more in the slides on that proposal. PELD it will be based on the median PELD in the nation. (If it comes up: living donors, DCD, and national share donors are not included in the calculation.)

National Liver Review Board Toolkit https://optn.transplant.hrsa.gov/resources/by- organ/liver-intestine/ Find training for review board members and liver programs on UNOS Connect A toolkit is posted on the OPTN site, that includes resources like FAQs, the full new policy language, the review board guidelines and guidance. Training is also available on UNOS Connect for liver programs and review board members

Questions?

Extra Slides

Acuity Circle Adult Donor Allocation Sequence Classification Candidates that are within this proximity of the donor hospital: And are: 1 500nm Adult or pediatric status 1A 2 Pediatric status 1B 3 150nm MELD or PELD of at least 37 4 250nm 5 6 MELD or PELD of at least 33 7 8 9 MELD or PELD of at least 29 10 11 12 MELD or PELD of at least 15 13 14 15 National Adult or Pediatric Status 1A 16 Pediatric Status 1B 17 18 MELD or PELD less than 15 19 20 21 For adults, the sequences are different. The acuity circles model first - Walk through the allocation sequence – out to 500nm for status 1a and 1b, then 150, 250, 500 in bands of 4 MELD points down to 29. Then 150, 250, 500 for 15-28 before national. Talk about the fact that we considered and modeled bands of 150/300/600 as well.

Acuity DCD/>70 Donor Allocation Sequence Classification Candidates that are within this proximity of the donor hospital: And are: 1 500nm Adult or Pediatric status 1A 2 Pediatric status 1B 3 150nm MELD or PELD of at least 15 4 250nm 5 6 Nation 7 8 9 MELD or PELD less than 15 10 11 12 For the donors over 70 or DCD, in acuity circles – bigger band so they stay closer longer

Adolescent Donor Allocation Sequence Classification Candidates that are within this proximity of the donor hospital: And are: 1 500nm Pediatric status 1A 2 Adult status 1A 3 Pediatric status 1B 4 Any PELD 5 MELD of at least 15 and 12 to 17 years old 6 MELD less than 15 and 12 to 17 years old 7 Nation 8 9 10 11 Any MELD and 12 to 17 years old 12 MELD of at least 15 and at least 18 years old 13 MELD less than 15 and at least 18 years old 14 Any MELD and at least 18 years old Allocation sequences are the same for both models for adolescent donors – 500nm circles with priority for pediatric candidates

Donor <12 Years Old Allocation Sequence Classification Candidates that are within this proximity of the donor hospital: And are: 1 500nm Pediatric status 1A 2 Nation Pediatric status 1A and 0 to 11 years old 3 Adult status 1A 4 Pediatric status 1B 5 Any PELD 6 MELD of at least 15 and 12 to 17 years old 7 MELD less than 15 and 12 to 17 years old 8 Pediatric status 1A and 12 to 17 years old 9 10 Pediatric status 1B and 0 to 17 years old 11 12 Any MELD and 12 to 17 years old 13 MELD of at least 15 and at least 18 years old 14 MELD less than 15 and at least 18 years old 15 Any MELD and at least 18 years old They are also the same for pediatric donors under 12 years old – 500nm with priority for the under 12 candidates and then other pediatric candidates