Ad Hoc Disease Transmission Advisory Committee Fall 2014

Recent Public Comment Proposal Aligning OPTN Policies with the 2013 PHS Guideline for Reducing Transmission of HIV, HBV, and HCV through Organ Transplantation Specific concerns from public comment feedback :  Need NAT testing standardization  Guidance on how to proceed with initial positive results (triplex tests)  Hemodialysis as a risk factor  Need educational materials for candidates considering increased risk organ offer  How to handle recipient consent for increased risk living donor

Aligning OPTN Policies with the 2013 PHS Guideline for Reducing Transmission of HIV, HBV, and HCV through Solid Organ Transplantation Board review - November 2014 without changes to proposed policy  DTAC will consider guidance to help educate members, including a recorded town hall meeting with PHS/CDC representation Recent Public Comment Proposal

Modifications to Deceased Donor Testing Requirements  Implemented September 1, 2014  Temporary manual solution in place until programming is complete to capture HIV combination antigen/antibody and syphilis testing requirements  More details available in July 2014 Policy NoticeJuly 2014 Policy Notice Policy Implementation Dates

New Donor Information Learned Post-Transplant, Sharing with Recipient Centers  Joint subcommittee evaluating potential failure points in communication process  Patient Safety Contact is not working effectively in many cases  Do you have suggestions on who should be the point of contact for this information? Is the on call coordinator a more appropriate contact point?  January 2015 public comment planned Ongoing Committee Initiatives

What to do when serologies affecting match run appearance are updated  If results are pending when match is executed, patients are not screened off even if results come back positive  Current policy does not require match run be re- executed if positive results are learned during allocation for the following tests:  HBV core Ab, HCV, HTLV (if completed), and CMV (intestine only) Ongoing Committee Initiatives

What to do when serologies affecting match run appearance are updated  Joint subcommittee may require the match run be re-executed for any positive serologies that could impact allocation/screening  Liver allocation may be especially sensitive -rapidly change list (both due to new listing and candidate status changes)  What to do when new, sicker candidates appear on new match ahead of the potential recipient who had provisionally accepted an offer?  January 2015 public comment planned Ongoing Committee Initiatives

 Dan Kaul, MD Committee Chair  Shandie Covington Committee Liaison Questions?