Region 5 Collaborative KAS Allocation Scenario Olivia Rivera RN, BSN, CCTN Organ Procurement Coordinator Lifesharing

Donor Summary 16 y/o male admitted with a self-inflicted GSW head Coded during the herniation process in the ICU with a total downtime of 12 minutes Declared brain dead on the same day of admission by clinical exam and apnea test. PMH: smoker (2 packs/3days), depression KDPI 4%

Allocation Overview Allocating all organs Heart/lung/liver » lists do not have any top recipients in need of a kidney. Kidney/Pancreas » 10 local KP recipients, followed by regional KP Kidney List » #1 100% CPRA patient in Ohio » #2,#3,#4 are local pediatric patients » #5 through #606 local centers

UNOS Policy Regarding KAS Policy 8: Allocation of Kidneys » 8.5 Kidney Allocation Classifications and Rankings

Lifesharing DSA Kidney Allocation Offer made to 100% CPRA in Ohio – no local backup offered at this time. Local kidney offers made » backup offers pending KP and 100%CPRA KP offers made locally » declined by local centers, no regional KP offers made. Crossmatch blood sent to Ohio at 14:00 on 2/28

Polling Questions Would your OPO send crossmatch blood out of state prior to OR? » Yes, send blood prior to OR » No, send crossmatch blood with kidney.

Polling Questions Would your OPO offer local backup for out of state recipients? » Yes, offer local backup » No, have kidney returned if positive x-match

Kidney Transport Challenges Crossmatch blood sent to Ohio at 14:00 on 2/28 OR 04:00 on 2/29 – cross-clamp at 06:41 Blood did not arrive until 10:00am on 2/29 (20 hours later) Blood frozen upon arrival. Ohio had to thaw blood and final crossmatch result came back positive at 17:20 Right kidney was already on the plane to be delivered to Ohio with a departure time of 17:45 (last flight out).

Kidney Transport Challenges Last minute calls made to get kidney off plane before takeoff Success in getting kidney off plane, but courier unable to verify that the package removed from flight was indeed the kidney 2 hours later the package arrived at the hospital, and verified that it was actually the kidney

Final Allocation Outcome Heart: Local 68 y/o man Lungs: Double lungs 24 y/o woman regionally Liver: 40 y/o women regionally Pancreas: 29 y/o man regionally Kidneys: » Left kidney 12 y/o girl at sequence #4 » Right kidney 30 y/o man local recipient at #7

Discussion Identify the challenges and successes that OPOs encounter with high CPRA kidney exports.

Tablework Questions During the allocation process, what is your OPOs top priority How are these priorities shared with your local transplant program What is one communication tool or process that would improve transparency between OPO and transplant programs