Histocompatibility Committee Spring 2015 Hi, my name is __________________ and I am going to provide an update on the Histocompatibility Committee.

Policies Effective Pending Programming Expanding HLA Typing Requirements Across Organ Types Board Approved: Nov. 2014 Expected Implementation: Fourth Quarter 2015 Require HLA-DQA and -DPB typing for deceased kidney, kidney-pancreas, and pancreas donors (for all other organ types if requested by transplant program) HLA-DQA and –DPB fields will be available in DonorNet® (for donor HLA) and Waitlist℠ (for unacceptable antigens) In November 2014, the Board approved a policy requiring OPOs to report HLA-DQA and –DPB on deceased kidney, kidney-pancreas, and pancreas donors. This change will not go into effect until IT programming is complete, which we anticipate to be by the end of 2015. Once the policy is implemented, there will be fields for DQA and DPB in DonorNet to report donor HLA and also in Waitlist to communicate unacceptable antigens. UNet will be programmed to automatically avoid donors when unacceptable antigens to these types are listed. Also, these additional HLA types will be mandatory when reporting HLA typing results on other organ types (heart, lung, and liver) if the transplant program requests HLA typing. HLA typing will also be mandatory for deceased islet donors and candidates.

What Members Need to Do OPOs/affiliated labs: update service agreements to include additional typing (if lab does not already perform typing for DQA/DPB) Transplant programs/affiliated labs: discuss and update protocol for MFI thresholds for reporting unacceptable antigens for these types We want to make sure that OPOs, transplant programs, and histocompatibility laboratories are prepared for these changes when they are implemented later this year. In order to prepare, OPOs and transplant programs should make sure that their affiliated laboratories know that the change is coming. OPOs may need to update their service agreements to include typing for these donor antigens. We encourage all laboratories to begin preparing for these changes and updating protocols with transplant programs regarding MFI thresholds for reporting unacceptable antigens for these types.

Questions? Dolly Tyan, PhD Committee Chair Dtyan@Stanford.edu Regional Rep name (RA will complete) Region X Representative email address Andrew Miller, Esq. Committee Liaison Andrew.Miller@unos.org Frequently asked questions: 1. Will these antigens be calculated into the CPRA? Not with this project. The CPRA is based on the frequency of HLA types from a specific donor cohort. Since fields for these types are being added with these new changes, we do not currently have frequencies for these HLA types. Adding these fields is the first step and these can be added into the calculation in the future once we have the frequencies. 2. Will the OPO be able to run a match if the results of these types are not yet available? The system will require that this donor information be entered for kidney, kidney-pancreas, and pancreas matches. For these matches, the OPO will still be able to run a match but the match will be closed at zero if information for these types is not entered. The OPO will not be able to make any offers for these organ types until the donor information is in DonorNet. This is the way DonorNet is programmed to operate currently for other required HLA information.