Thoracic Organ Transplantation Committee Spring 2014

Ongoing Committee Initiatives Heart Lung Allocation Policy Clarification Heart Allocation Policy Revision Pediatric Lung Allocation Policy Review ECMO Data Collection The Thoracic Committee has spent a lot of time over the years trying to clarify heart-lung allocation policy. In February, the OPO Committee reviewed a policy clarification issued by the Thoracic Committee, and helped determine how heart-lung blocks should be allocated based on the policy clarification. The OPO Committee is working closely with the Thoracic Committee to draft a guidance document, so that all OPOs allocate heart-lung blocks in the same manner. The Thoracic Committee is working with the OPO Committee and UNOS staff to educate OPOs on how to allocate heart-lung blocks according to the guidance document, and to educate transplant programs on proper listing practices to ensure heart-lung candidates appear on matches when they should. The Thoracic Committee is also forming a work group to attempt to revise heart-lung policy altogether. The Heart Subcommittee continues to work on heart allocation policy revision. They developed a straw man model of the potential new allocation system. It includes additional tiers to better stratify candidates based on medical urgency and revisions of qualifying criteria for each tier. The heart subcommittee is working with SRTR to prepare the straw man for a TSAM analysis, which the heart subcommittee will analyze to determine whether the proposed changes would positively impact the waiting list mortality and post-transplant survival rates. In addition to the SRTR’s support, the Heart Subcommittee based the proposed changes on OPTN data, clinical experience, community input, and feedback from the Forum on US Heart Allocation Policy, which took place in Dallas last November. In addition to distributing the Adolescent Classification Exception proposal for public comment, the Lung Subcommittee is continuing to review pediatric lung allocation policy to determine whether additional improvements can be made to the system. The Subcommittee is working closely with the SRTR to model outcomes of various potential modifications. The Lung Subcommittee is also working to develop a cost-effective solution to collect data for lung candidates supported by ECMO during their time on the waitlist. The Committee hopes to distribute a proposal for the collection of ECMO data during the Fall 2014 public comment cycle.

Questions? Steven Webber, M.D., MBChB, MRCP Committee Chair steven.a.webber@vanderbilt.edu Name Region # Representative Email Liz Robbins Callahan Committee Liaison liz.robbins@unos.org