1. OPTN/UNOS Kidney Transplantation Committee
Spring 2017
Hello, my name is _______________ and I am the region __ representative to the Kidney Committee and I will be presenting the Kidney Committee Update.

2. Kidney Committee Update
SLK Allocation Policy Implementation (Update)
KAS Clarifications & Clean Up Implementation (Update)
“Improving Allocation of Dual Kidneys” Concept Paper (Update)
“Improving Allocation of En Bloc Kidneys” Public Comment Proposal
Today, I’ll be updating you on the IT implementations for SLK and KAS, and I’ll also be presenting on the Committee’s two policy projects this year, improving en bloc and dual kidney allocation.

3. Implementation of the Simultaneous Liver-Kidney (SLK) Allocation Policy
The Simultaneous Liver Kidney (SLK) Allocation policy that was approved by the Board in June 2016 is slated to be implemented during July 2017.
I want to go over the general timeline for implementation, remind you of the key requirements, and describe the tools that UNOS will provide you in preparation for the implementation.

4. Implementation Update
SLK Allocation
Primary Changes: SLK medical eligibility criteria, SLK allocation requirements, safety net for liver recipients registered on kidney waiting list within a year after liver transplant
Board Approved: June 2016
Effective Date: Estimated for July 2017
The new policy includes medical eligibility criteria for SLK candidates, SLK allocation rules, and provides a safety net for liver recipients who end up registered on the kidney waiting list within a year after their liver transplant.

5. How will the OPTN implement this proposal?
Regional Meetings (Feb/March)
Edu on policy/
systems
New data entry (May 2017)
Town Hall webinar
ATC (May 2017)
OPO education
Allocation rules in effect
(July 2017)
TODAY
Here is a general timeline for the next several months.
In May, prior to the release of new data fields, we provide a webinar to outline the policy and system changes. We are also providing a Frequently Asked Questions document. The policy changes will require programs to enter new data on the liver waiting list (for liver-kidney allocation) and the kidney waiting list (for those candidates who may be eligible for the safety net prioritization).
In late May, UNOS will begin displaying the new fields on both the liver and kidney waiting lists in order to allow programs to begin entering data. The SLK working group polled a panel comprised of transplant administrators, coordinators, OPO staff, liver and kidney surgeons and physicians how long programs would need to complete data entry (as of last April, there were approximately 1,200 candidates listed for SLK nationwide). The panel unanimously agreed that two months was a sufficient timeframe.
UNOS will allow programs at least two months to complete the data entry phase. About halfway through the data entry phase, UNOS will hold a town hall webinar to allow transplant program staff to ask questions regarding the new requirements and data entry. There will also be a presentation at ATC concerning the new policy requirements and system changes. UNOS plans to provide OPO specific education in May as well. We expect the policy and system changes to go into effect in July.
Are there any questions on SLK before I move on to our KAS update?

6. Kidney Allocation System (KAS) Clarifications & Clean-Up
As many of you know, the Board of Directors approved the Committee’s proposal on KAS Clarifications and Clean Up in June Many of the policy changes included in this proposal did not require programming and were previously implemented on September 1, 2016.
REFERENCE ONLY (do not read):
Policies implemented 9/1/16: Policies 5.3.C (Informed Consent for Kidneys Based on KDPI Greater than 85%), 8.2.B (Deceased Donor Kidneys with Discrepant Human Leukocyte Antigen (HLA) Typings), 8.3 (Kidney Allocation Points), 8.5.C (Informed Consent for Kidneys Based on KDPI Greater than 85%), 8.5.D (Sorting Within Each Classification), 8.5.E (Allocation of Kidneys by Blood Type), 8.5.F (Prior Living Organ Donors), 8.5.G (Highly Sensitized Candidates), 8.5.H (Allocation of Kidneys from Deceased Donors with KDPI Scores less than or equal to 20%), 8.6 (Double Kidney Allocation), 8.7.A (Mandatory Sharing), 8.7.B (Choice of Right versus Left Donor Kidney), 8.7.C (National Kidney Offers), and 8.7.D (Kidney-Nonrenal Organs Allocated and Not Transplanted)

7. Implementation Update
KAS Clarifications & Clean-Up
Approved by the Board: June 2016
Primary Change Yet to Be Implemented: Mandatory sharing policy will be deleted, OPOs will have to follow the match run
Anticipated timeframe for implementation: Mid-2017
Changes that did not require IT programming were effective Sept. 1, 2016
However, there are two policy changes that required IT programming that have not yet been implemented.
Changes that have yet to be implemented primarily affect mandatory sharing policy.
Policy 8.7.A Mandatory Sharing: Changes include removing the time requirements for making offers to highly sensitized candidates with % CPRA in match classifications 1-10 of Tables 8-5 through Table 8-8. OPOs will have to follow the kidney-alone match run and will not be permitted to use “Refusal Reason 881 – Mandatory Sharing Offer Requirements Met.” This bypass code will be deactivated in UNet. OPOs may still use other available bypass codes to assist with organ placement.
This implementation will also include updates to the match classification labels in policy Table Once implemented, these label changes will also be reflected on the match run.
The anticipated time frame for implementation is mid-2017.
Are there any questions I can answer about the KAS Clean Up implementation before I move on to our En Bloc kidney allocation project update?
REFERENCE NOTES: ONLY IF ASKED ABOUT SPECIFIC OTHER CHANGES PREVIOUSLY IMPLEMENTED ON SEPT 1:
Policy 5.3.C Informed Consent for Kidneys Based on KDPI Greater than 85%: Some of you may remember that the Kidney Committee requested specific public comment feedback on the timeframe for obtaining informed consent for multi-organ candidates for kidneys with a KDPI greater than 85%. Based on the public comment feedback, the Kidney Committee extended the time frame for obtaining informed consent. The policy will now require that transplant programs obtain written, informed consent from each multi-organ candidate prior to transplant for kidneys with a KDPI score greater than 85%. That change will not prohibit a transplant program from obtaining consent earlier (e.g., at the time of listing). Kidney-alone candidates will still need to provide informed consent prior to receiving offers for kidneys with a KDPI greater than 85%
Policy 8.2.B Deceased Donor Kidneys with Discrepant Human Leukocyte Antigen (HLA) Typings: If a recipient HLA laboratory identifies a different HLA type from the donor histocompatibility laboratory’s HLA typing, Policy 5.9: Released Organs, will be the prevailing policy if the discrepancy cannot be resolved and the originally intended recipient cannot be transplanted. The policy does not direct which HLA typing must be used because there may be unknown consequences for patient safety by requiring that the donor lab HLA typing always be used instead of the recipient lab HLA typing, or vice versa. The OPO has the discretion of allocating the kidney based on the original donor lab HLA typing or the recipient lab HLA typing.
Policy 8.7.C National Kidney Offers: Policy that allowed an importing OPO to select alternate candidates if a national kidney offer could not be transplanted into the originally intended candidate has been removed. An importing OPO must now follow Policy 5.9: Released Organs. The importing OPO can re-allocate the kidney only if the host OPO has delegated responsibility for re-allocation to the importing OPO. Re-allocation of the kidney to other candidates still would be according to the allocation policies whether it was allocated by the host OPO, the importing OPO, or the Organ Center.
Policy 8.7.D Multi-Organ Combinations Allocated but Not Transplanted: If a kidney is allocated as part of an accepted multi-organ combination offer that does not result in a transplant, OPOs must reallocate kidneys that are not transplanted in multi-organ combinations according to Policy 5.9: Released Organs. That policy requires that the organ be allocated to other candidates according to the organ-specific policies, such as the KAS allocation sequences.
There were also updates to references and other clerical changes.