Revision Process for the PHS Guideline for Reducing HIV, HBV and HCV Transmission through Solid Organ Transplantation Matthew J. Kuehnert, M.D. Office of Blood, Organ and other Tissue Safety Advisory Committee on Organ Transplantation February National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

PHS Guideline Development  “Guidelines for Preventing Transmission of Human Immunodeficiency Virus Through Transplantation of Human Tissue and Organs” published in 1994 by the Public Health Service (PHS)  Agreement that PHS guidelines need revision  Association for Organ Procurement Organizations (AOPO), followed by other transplant organizations, sent letters to CDC suggesting guideline revision in 2008  Objective process developed for PHS guideline revision and update

Important Differences in Focus – 1994 versus Revised Draft Guideline 1994: PHS Guideline for Preventing Transmission of Human Immunodeficiency Virus through Transplantation of Human Tissue and Organs – Organs and tissues; banked breast milk and semen – Transmission of HIV only Revised Draft: PHS Guideline for Reducing HIV, HBV and HCV Transmission through Solid Organ Transplantation – Organs only – Transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) – Evidence-based process

Evidence-based Process for Revision HHS agencies and external experts from transplant community provided input CDC lead for PHS agencies in developing a draft Recommendations based on systematic review of the best available evidence Evidence review conducted by: – Center for Evidence-based Practice (CEP) at University of Pennsylvania – ECRI Institute/Evidence-based Practice Center (EPC)

National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion 5 5 Expert Panel (EP) Experts in Consent Issues, Hepatitis and HIV Content, and Laboratory Medicine; OPO Representative; Physicians in Transplant, Transplant ID, and Transplant Surgery Review Committee (RC) Representatives from AOPO, AST, ASTS, CSTE, NATCO, UNOS, Industry; and Ad Hoc Members PHS representatives from CMS, FDA, HHS/OPHS, HRSA, and NIH Advisors for Guideline Development

National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion Phase 1: Organize Advisors for Guideline Development Phase 2: Preliminary Literature Search in Support of Questions for Systematic Review Phase 3: Development of Questions for Systematic Review and Analytic Framework Phase 4: Production of Evidence Report Phase 5: Guideline Development PHS Guideline Development Methodology Five Phases PHS Guideline Development Methodology Five Phases

Categories of PHS Guideline Recommendations  Donor Risk Assessment  Donor Screening  Includes Table of risk factors for recent infection of HIV, HBV, HCV  HBV-Infected Donors and Transplantation  HCV-Infected Donors and Transplantation  Recipient Informed Consent  Recipient Testing  Donor and Recipient Specimen Collection and Storage  Tracking and Reporting of HIV, HBV and HCV

Process for Revision of PHS Guideline  HHS offices and agencies, including CDC, HRSA, FDA, and CMS, reviewed and approved the draft Guideline  Federal Register Notice  Draft guideline accessed at  90-day public comment period - ended 12/23/11  Approximately 100 comments were received  All comments are being reviewed

Next Steps For Finalizing the PHS Guideline  Comments mapped to recommendations  Convene PHS Revision Task Group  Review comments and change options  Agree on changes to the guideline  Reconvene Expert Panel and Review Committee  Review guideline and provide input  HHS agencies consider any suggested changes  Submit guideline for HHS clearance  Publication as final Guideline* *Recommendations will not be regulation or policy

Questions or Comments? For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion