1. Pancreas Transplantation Committee Update
Spring 2014

2. Policy Implementation Dates
June 2014: new pancreas qualifying criteria fields available for KP candidates
UPDATE KP candidate’s information
Fall 2014: PA/KP Allocation System
As you may recall, in November 2010 the Board of Directors passed the proposal for a new pancreas and kidney-pancreas allocation system. This was titled, “Proposal to Develop an Efficient Uniform National Pancreas Allocation System”. One of the main changes to this policy is that pancreas and kidney-pancreas candidates will be combined onto one match run list. In addition, kidney-pancreas candidates must now meet new qualifying criteria.
In June 2014 new pancreas qualifying fields, for pancreas portion of the kidney-pancreas candidates, will appear on the waitlist for pancreas and kidney-pancreas candidates. The new fields that will appear in June 2014 are:
On insulin
Insulin date
C-peptide
C-peptide date
Please update your kidney-pancreas candidate’s information by filling in the new fields before the new PA/KP allocation system is implemented.
The new PA/KP allocation system will be implemented in the third quarter of 2014.

3. Ongoing Committee Initiatives
Implementation of PA/KP Allocation System
Policy definition for pancreas graft failure: C-peptide data collection project
Bylaws Review
We are currently working on the following projects:
Implementation of PA/KP Allocation System:
The Committee will release a patient brochure on pancreas, kidney-pancreas, and islets in late Spring This brochure is slated to be released in conjunction with educational efforts for the implementation of the new pancreas allocation system. The brochure’s format will coincide with existing organ-specific patient brochures and aims to answer frequently asked patient questions regarding pancreas, kidney-pancreas, and islet allocation.
C-peptide Data Collection:
In order to better define the pancreas graft failure definition, our Outcomes Subcommittee is currently collecting C-peptide data. This project consists of collecting pancreas transplant recipients’ C-peptide values at pre transplant and graft failure and it will allow members to determine what C-peptide value and methodology should be stated in the pancreas graft failure definition. The Committee will compile the data and analyze the results to determine a C-peptide threshold or change in value that correlates with graft failure.
Currently, 10 centers are participating in the study. A preliminary review of the findings show that C-peptide data is stored in varying formats. The formats include both continuously and categorically measured values, and on different scales. So far, the results are not nationally representative enough to make specific conclusions. We cannot currently decipher how variable, reliable, or informative the data is at either the patient or center specific level until we have aggregated data from all of the participating centers.
Bylaws Review:
The Committee has been reviewing several areas of the Pancreas and Islet Bylaws. The Committee’s changes to the Bylaws was scheduled to be released for the fall 2014 public comment cycle. However, the Joint Societies Steering Committee asked to review this project, as well as five other membership requirement related projects. Currently, a Joint Societies Working Group is being formed and the Joint Societies Working Group will convene to provide a recommendation on the Pancreas Committee’s Bylaws Review project. Once the Joint Societies Working Group gives the Pancreas Committee a recommendation on its Bylaws Review project, the Pancreas Committee will continue its work on the project, and release it for the next available public comment cycle.

4. New Committee Initiatives
Pancreas as a Part of a Multivisceral
Pancreas Underutilization
Pancreas as a Part of a Multivisceral:
The Committee voted on the following definitions and names for multivisceral and modified multivisceral transplant:
Multivisceral transplant: Liver-Intestine-Pancreas Transplant
Modified multivisceral transplant: Intestine-Pancreas Transplant
The Committee continues to work on this project and plans to incorporate these definitions into a future public comment proposal.
Pancreas Underutilization:
The goal of the Pancreas Underutilization project is to figure out why there is a decline in the number of pancreas transplants and why a significant number of transplantable pancreases are not transplanted. The Committee will study data in order in order to better understand the trends in volume of pancreas transplants. The Committee will discuss everything from organ offer to implantation. The project will entail a broad look into allocation changes, facilitated pancreas allocation updates, and issues from procurement to implantation (i.e. technical challenges, communication challenges, best practices, etc.) The project includes the goals of two previous, but inactive and unresolved, projects: Investigating Sources from Pancreas Discards and Facilitated Pancreas Review. Regarding the Facilitated Pancreas Review aspect of this project, the Committee will revise the OPTN facilitated pancreas policy. The revisions will include eligibility requirements for a center to utilize the facilitated pancreas policy as well as create monitoring initiatives to ensure that those centers participating in facilitated pancreas utilize this opportunity in the most efficient and equitable manner. We anticipate this will go out for public comment in Spring 2015.

5. Questions? Jonathan Fridell, MD Committee Chair jfridell@iupui.edu
Name
Region # Representative
Kristina Tyler, JD Committee Liaison