1. Pancreas Transplantation Committee
Fall, 2012 Public Comment Cycle

2. Ongoing Committee Initiative
Pancreas for technical reasons
Determine how pancreas used for a technical reason should be reported
Problem Statement:
It is not clear how pancreata used for technical reasons should be reported. Transplant centers and OPOs do not always agree on the appropriate disposition code (transplanted or not transplanted) for pancreata that are used for technical reasons as part of multi-organ transplants, so the disposition can be reported differently. This discrepancy in reporting results in data errors.
Status:
A working group including members from the Pancreas, Pediatric, Liver, and Transplant Administrator, and OPO Committees met to develop a solution for reporting a pancreas when it is used for technical reasons. The goal is for both the recipient removal reason entered by the transplant center and the disposition code entered by the OPO to be in agreement about whether the pancreas has been transplanted or not. The work group explored both a programming and non-programming option. The work group has developed a non-binding recommendation based on donor weight. However, this recommendation would require a policy change to be binding, and there was not enough comfort with the recommendation for every circumstance to immediately pursue it.
UNOS staff has been working on how to program a solution that more completely addresses all the problems relating to the reporting of pancreas for technical reasons. IT staff is currently providing a high level estimate on this approach. Once this estimate is available, staff and the Committee will assess whether this level of effort would be reasonable to propose for the problem. If so, then there would also be a public comment proposal to add policy language to define an “organ for technical reasons.”

3. New Committee Initiative
Defining pancreas graft failure
Transplant centers report graft failures at different events (death, re-transplant, re-listing)
Reporting standards needed in order to compare transplant centers
Problem Statement
There is no standard definition in the pancreas transplantation community for pancreas graft failure. It is currently defined as death, re-transplant, re-listing, or reported graft failure. OPTN policy defines pancreas graft failure as removal of the transplanted pancreas within two weeks of transplant. However, this removal of a pancreas does not enable understanding of the reason why the pancreas failed.
Transplant centers report graft failures at different points. For example, some programs report a graft as having failed if there is any return to insulin therapy, whereas other programs only report a pancreas as having failed if insulin use goes above a certain threshold. As the MPSC begins to use statistical models to assess pancreas program performance, this difference in reporting could impact whether a pancreas program gets flagged for outcomes issues. Essentially, reported pancreas graft failure cannot be compared across centers if it is not being reported according to the same standards.
Proposed Solutions
The Committee would like to work with the SRTR to develop a definition of pancreas graft failure that all centers would use when reporting pancreas graft outcomes. At a minimum, the definition would appear in help documentation. Another option would be to collect a small number of clinical values, such as insulin usage, and define graft failure according to those clinical values. This second option would not require a transplant center to know and use the definition for it to be effective. It is possible that this definition will be included in policy.

4. Questions? Chairman – David A. Axelrod, MD david.axelrod@hitchcock.org
Vice-Chairman – Jonathan A Fridell, MD
Committee Liaison – Vipra Ghimire
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