Thoracic Organ Transplantation Committee Fall 2014

Policy Implementation Dates LAS Modification – February 2015 Implementation includes: Changes to covariates and coefficients in LAS calculation Serial serum creatinine and serial bilirubin as factors in the LAS calculation Display waitlist urgency, post-transplant survival and transplant benefit measures in UNetSM Ability for candidates less than 12 to request “other” diagnosis from LRB The LAS modification project will be implemented in February 2015. A number of LAS-related projects will be rolled out at the same time. Most notably, the effort includes the changes approved during the November 2012 Board meeting, which are modifications to the covariates in the waiting list and post-transplant survival models, coefficients of the covariates, and baseline waiting list and post-transplant survival rates used in the LAS calculation. While transplant programs already report serum creatinine for their lung candidates, the changes to the calculation require transplant programs to report serum creatinine serially. The addition of bilirubin to the LAS calculation will also be implemented with this effort, which must also be reported serially. Another change transplant programs will notice is the display of waitlist urgency, post-transplant survival and transplant benefit measures in UNet. These measures are used to calculate the candidate’s LAS. Finally, for candidates less than 12, transplant programs will now have the ability to submit an exception request to the Lung Review Board for an “other” diagnosis if the candidate’s true diagnosis is not included in the diagnosis drop-down list in Waitlist. Educational activities are being planned and you will be able to access them closer to the implementation date.

Ongoing Committee Initiatives Heart-Lung Allocation Guidance Document Pediatric Lung Allocation Policy Review Revision of Adult Heart Allocation Policy The Board of Directors approved a Heart-Lung Guidance document at its recent meeting. The guidance document is targeted mainly at OPOs with the goal of helping OPOs allocate heart-lung blocks consistently nationwide. The Committee continues to review pediatric lung allocation policy to ensure it is fair. We have extensively reviewed data and modeling to determine whether any modifications would increase the fairness of the allocation system. Thus far, we have not found any inherent unfairness in the current policy, and have not modeled any changes that would increase its fairness without adversely affecting other age groups. As part of this project, the Committee is also determining whether to permit ABO incompatible lung transplants for candidates less than 2. This policy would be modeled after the pediatric heart ABOi policy. We hope to have a proposal ready for public comment in January 2015. We are also continuing to our efforts to revise the adult heart allocation policy. The revisions will include the addition of more tiers to better stratify candidates based on medical urgency. We are also working on how to identify and prioritize sensitized candidates within this new scheme.

New Committee Initiatives EVLP Data Collection Finally – we are working on a proposal to collect data for transplant recipients that have received lungs that have been perfused prior to transplant. We hope to circulate this proposal for public comment during the cycle that begins in January 2015.

Questions? Joe Rogers, MD Committee Chair joseph.rogers@duke.edu Liz Robbins Callahan, Esq. Committee Liaison liz.robbins@unos.org