1. Thoracic Organ Transplantation Committee
Fall 2017

2. Policy Implementation Dates
Modify Adult Heart Allocation System
Two phases:
Release 1: Waitlist changes
Release 2 – DonorNetSM changes
Gap of 30 days between both releases
Full implementation estimated Q1 2018, but under review
The proposal to modify the adult heart allocation system went out for two rounds of public comment in The OPTN Board of Directors approved the proposal during their December meeting. This proposal suggested that we modify the adult heart allocation system to better stratify the most medically urgent heart transplant candidates, reflect the increased use of mechanical circulatory support devices (MCSD) and increased prevalence of MCSD complications, and address geographic disparities in access to donors among heart transplant candidates.
Implementation is contingent on IT programming and notification to members and will occur in two phases. Phase 1 will entail changes to Waitlist to allow transplant programs to submit new justification forms. Phase 2 will encompass changes to DonorNet and the new heart allocation algorithm will be fully implemented. There will be 30 days between the two releases to allow programs to bring patients in for any necessary testing before submitting the relevant justification forms. On the date the new changes go live, candidates will be assigned to the new statuses.

3. Modification to the Adult Heart Allocation System
Planned Educational Offerings:
2017
October: Policy training
2018
January: Transition training
February: How to talk to patients & System training
March: RRB training
April: OPO training
As part of the implementation efforts, the Committee is developing a robust educational program for the community, including offerings tailored to transplant programs, OPOs and review boards. The first module will be offered in October and will provide an overview of the policy changes. We will offer additional training over subsequent months, into Watch for additional information and exact dates.

4. Committee Projects Heart: Lung: Regional Review Board Guidance for:
Adult Congenital Heart Disease Exception Requests – out for public comment now
Hypertrophic and Restrictive Cardiomyopathy Exception Requests – future public comment cycle
Lung:
Modify Lung Transplant Follow-up Form to Include CLAD Data
Refine and Clean-up LAS
This is a summary of other projects the Committee is currently working on. The Committee currently has a proposal out for public comment, “Regional Review Board Guidance for Adult Congenital Heart Disease Exception Requests”. This proposal is on the non-discussion consent agenda, but I encourage my thoracic colleagues to review it and post your feedback on the OPTN website. This guidance, along with guidance for hypertrophic and restrictive cardiomyopathy exception requests, currently under development, were undertaken to address specific concerns we heard from the community during both rounds of public comment for the heart proposal.
We are also taking on a project to modify data collection to the “Graft Function” section of the lung transplant follow-up forms. Finally, as with other major allocation system projects, we seek to explain LAS post-implementation data trends as well as a number of clarifications to lung allocation policy that generated questions from the community.

5. Questions?
Kevin Chan, MD Committee Chair Kimberly Uccellini, MS, MPH Committee Liaison