Guidance on Effective Practices in Broader Distribution Operations and Safety Committee

What problem will the proposal solve? Recommendation from the Ad Hoc Geography Committee Broader distribution discussions: Concerns about cost and transportation Lack of information about best practices to address logistical challenges Limited data on cost and transportation This guidance was developed based on a recommendation from the Ad Hoc Geography Committee. During discussions regarding the broader distribution of organs, there was concern raised about increased cost of transporting organs. There is also limited information about best practices for dealing with logistical challenges. Finally, there is a limited amount of data available on cost and transportation associated with broader distribution.

What are the proposed solutions? Develop a guidance document to help OPOs and transplant hospitals transition to broader organ distribution Provide recommendations to the overall allocation process What are the proposed solutions? Develop a guidance document to help OPOs and transplant hospitals transition to broader organ distribution Provide recommendations to the overall allocation process

Guidance Document Development Transportation Report Questionnaire – 54 of 58 OPOs responded, 10 transplant centers Report provided to the Liver Committee and Board of Directors Effective Practices Guidance Document Identified topics Working groups drafted the content The Committee worked on two things concurrently Transportation report – Questionnaire was developed and committee members contacted the OPOs (54 of 58 responded) and 10 transplant centers that handle transportation. This report was provided to the Liver Committee (included as an exhibit to the liver proposal briefing paper that was sent to the Board of Directors in December). This will also be included as an appendix to the guidance document. Guidance document – the Committee identified the topics and formed working groups to work on each section.

Topics addressed Building relationships to optimize operations Transportation resources Streamlining communications and information distribution Histocompatibility considerations with broader geographic organ distribution Organ allocation procedures Recognizing seasonal and geographic endemic infection in organ donors Establishing the time of organ recovery Building relationships to optimize operations – this section focuses on collaboration between OPOs and transplant centers that have historically not worked together as much because of the DSA/region framework of allocation. Transportation resources – this section touches on the need for members to analyze available aviation resources to prepare for broader distribution Streamlining communications and information distribution – this section provides recommendations for improving DonorNet and other means for file sharing for imaging and other test results. Histocompatibility considerations with broader geographic organ distribution – this section contains recommendations regarding the use of virtual crossmatching and encourages early testing and distribution of donor specimens. Organ allocation procedures – This section includes suggestions for effective waitlist management for TXCs, delaying the match run until ready to allocate organs enables the most accurate and up-to-date candidate sequencing, and ensuring backup offers. Recognizing seasonal and geographic endemic infection in organ donors – this section was developed in collaboration with the DTAC and reminds members of the challenges of seasonal and geographic infections. Establishing the time of organ recovery – this section reminds members of the importance of open and collaborative discussions between OPOs and all parties accepting organs in order to reduce delays in organ recoveries.

Topics addressed Organ procurement surgeon models Procurement team staffing models Organ procurement-related billing Establishing fair market value for organ procurement activity Organ procurement malpractice coverage considerations Data metrics Organ procurement surgeon models – this section provides recommendations for evaluating surgical team capabilities that are impacted by broader distribution. This includes use of employed surgeons, affiliated surgeons, and non-employed/non-affiliated surgeons. Procurement team staffing models – this section discusses strategies for preventing burn-out and fatigue such as using local surgeons or recovery teams to procure organs on their behalf, this will reduce the amount of air travel on procurement teams. The next three sections address the reimbursement process for ensuring that surgeons and procurement teams are compensated for their time as well as considerations for malpractice coverage as it relates to transplant procedures. Data metrics – this section lists the metrics used for post-policy change monitoring but also includes a recommendation to consider updating the potential transplant recipient codes to collect better data.

How will members implement this proposal? No member action required Guidance will be available on the OPTN website if approved by the Board of Directors

Specific Question for Feedback Does the transplant community support additional data collection necessary for OPTN Committees to evaluate the logistical impact of broader distribution? The Committee is also seeking feedback on whether the community would support additional data collection in the future to help OPTN Committees evaluate the logistical impact of broader distribution? For example, collecting information like the “mode of transportation” used to transport organs.

Questions?