OPTN OPTN Kidney Paired Donation Pilot Program Ruthanne L Hanto RN, MPH Program Manager, OPTN KPDPP Regions 4 Meeting May 11, 2012

OPTN Discussion  Data  Guidelines and Proposed Policy  OPTN KPDPP Process  Integration with UNet SM  How to join  Webinar information  Questions

OPTN DATA

OPTN Transplant centers who had preformed at least 1 KPD transplant in the U.S. Segev, D KPD Consensus Conference April 2012 Dulles + HI

OPTN Living Donor Transplants By Donor Relation Based on OPTN data as of March 30, 2012

OPTN Transplant centers participating in the OPTN KPDPP  118* Transplant centers  11 Regions *As of May 9, 2012

OPTN Candidate and Donor Characteristics May 3, 2012 Match Run CharacteristicCandidates Donors Total (5 NDD) Blood Type O67.3% (101) 32.3% (54) CPRA ≥ 80%56.7% (85) Willing to travel to matched center7.3% (11) 32.3% (55) Willing to ship/accept a shipped kidney from/to any center 92.7% (139) 97.0% (162)

OPTN Total transplants and pending transplants to date

OPTN GUIDELINES/ PROPOSED POLICY

OPTN Why is the OPTN a Pilot Program?  To work out the logistics of KPD prior to setting policy  Currently participating transplant centers abide by Guidelines  Guidelines converted to public policy – proposal out Spring 2012

OPTN Starting your KPD Program  Identify key personnel  Put processes in place  Get the word out to your patients  Identify potential KPD pairs

OPTN OPTN Bylaws Requirements  Approved living donor kidney program  Notify OPTN Contractor in writing  Provide primary and secondary KPD contact OPTN KPDPP Agreement to Participate

OPTN Requirements for Participation  Candidate On waiting list  Donors 18yo or older Listed in KPD only once

OPTN OPTN KPDPP Required Consents  Agreement to Participate Form (separate)  Donor Education Documentation Forms  Candidate Education Documentation Forms  Authorization for Disclosure of Medical Information – HIPPA (no template – yet)  Accepting/shipping a living donor kidney

OPTN Data Requirements  Donor & Candidate meet requirements for donation and transplantation  Required R data fields & Eligible* data fields  Tissue typing requirements  ABO verification  A 2 and A 2 B matching  Donor and Candidate choices

OPTN Required Policies  When/how matched donors and candidates can meet (communicate)

OPTN PROCESS

OPTN Match Run Announcement

OPTN Match Run Announcement

OPTN Match run schedule posted Data entry deadline Eligibility reports ed date – May 24 th in UNet SM Match run date

OPTN Match Run  Twice/month

OPTN Types of KPD

OPTN Donor Chains

OPTN Prioritization Points Priority Points Per Candidate Base match per candidate (based on 200 points for a 2-way match)100 points Zero antigen mismatch with the matched donor200 points Highly sensitized candidate (CPRA ≥80%)125 points Prior living donor status of the candidate150 points Pediatric candidate (age <18 years)100 points Waiting time accumulated within the KPD program 2 points per match run Geographic proximity with the matched donor (i.e. transplant center, local, regional) 75,50,25 points, respectively Candidate’s other antibody specificities present in donor-5 points

OPTN Edge Weights

OPTN Match offers Final acceptance deadline

OPTN Finances KPD Financial Recommendations KPD Financial Checklist KPD Financial Memo

OPTN KPD Logistics  2 & 3 way exchange same day  Chains sequential  Candidate receives kidney before donor donates  Donor nephrectomy schedules within 3 weeks of paired candidate’s transplant

OPTN KPD Logistics Transporting Kidneys  Chain of custody for shipping kidneys  UNOS works with center, OPO, courier in setting up transportation

OPTN “Every system is perfectly designed to get the results it is getting” - Don Berwick

OPTN Process Improvement  Increase the number of match runs  Decrease matches declined due to HLA issues  Allow Bridge Donors in the system  Decrease matches declined due to inactive pairs

OPTN Process Improvement  Increase the number of match run 1x – 2x/month  Decrease matches declined due to HLA issues HAC Donor pre-select  Allow Bridge Donors in the system Proposal out for public comment for bridge donors  Decrease number of decline due to inactive pairs Education Eligibility in UNet SM

OPTN Automated Solution Released in Phases  Data entry  Eligibility reports  Donor pre-select  Display of match offers  Tracking of matches,acceptance,refusal  View matched donor information  Logistics sheet  Contact information  Match communication blog

OPTN Unique to OPTN KPDPP  Transparency & Oversight  Priority Points – consistency in matching  Fully automated computer system integrated with UNET™  No additional OPTN or UNOS fees

OPTN HOW TO PARTICIPATE IN THE OPTN KIDNEY PAIRED DONATION PILOT PROGRAM (KPDPP)

OPTN Entering Pairs in OPTN KPDPP  Center signs agreement  Center activated in UNet™  Site administrator grants staff access  Enter pairs OPTN KPDPP Agreeme nt to Participat e

OPTN Demystifying the OPTN Kidney Paired Donation Pilot Program  KPD Basics Recording Available  Guidelines to KPD Finances: Who Pays for What Recording available  Unacceptable antigens in KPD June 20 th 2:00 – 3:00 PM ET  Navigating the Logistics of KPD July 25 th 2:00 – 3:00 PM ET A B DR DP DQ

OPTN Everything you want to know about the OPTN KPDPP