Definition of Transplant Policy Oversight Committee (POC) Fall 2014

 Questions from OPTN/UNOS members  What is the definition of a transplant?  Which date should be reported as the transplant date?  Current disconnect between policy definitions and clinical practices  Proposed definitions will help align policy requirements with current clinical practice The Problem

 Patient receives liver transplant, but organ is larger than expected. Surgical team does not immediately close the abdomen. Patient is removed from the OR and dies three days later.  Disconnect: According to current policy, the transplant was never completed The Problem – Single Organ Transplants

 Recipient leaves OR after receiving first organ transplant and returns to OR next day for a second organ from same donor  Current policy: date of 2 nd organ transplant recorded as date of first organ’s anastomosis  first transplant could have occurred more than 24 hours earlier  Disconnect: program could need to remove a patient from waiting list before the second organ is transplanted The Problem- Multi-organ Transplants

 Maintain current reporting elements, while capturing existing clinical practice  Ensure data reported to the OPTN reflect what actually happens in a single-organ or multi-organ transplant Goal of the Proposal

Definition of Organ Transplant  An organ transplant BEGINS at anastomosis of the organ, and an organ transplant would be COMPLETE when: The cavity is closed and final stitch or staple applied or The recipient leaves the operating room, even if the chest or abdominal cavity cannot be closed How the Proposal will Achieve its Goal

Definition of Transplant Date:  Transplant date for an organ would be determined by the start of anastomosis for that organ, so you could have a multi-organ transplant occur on two different days  The beginning and completion of an islet infusion would not change How the Proposal will Achieve its Goal

 Accurately report data based on the proposed language  Apply the new definitions of organ transplant and transplant date when reporting in UNet SM What Members will Need to Do

 Yolanda Becker, MD Chair, Policy Oversight Committee  Leigh A. Kades, MA Liaison, Policy Oversight Committee Questions?