1. Pancreas Transplantation Committee
Spring 2016

2. Recent Public Comment Proposals
Proposal To Revise Facilitated Pancreas Allocation (FPA)
Board approved December 2015 with the following post-public comment changes:
Qualifying criteria changed from 5 import pancreas transplants in one of the two previous years to 5 within the two previous years
Change to programming that will prevent OPOs from using FPA until all local pancreas and kidney-pancreas offers have been declined
To be implemented pending programming and notice to members
In December the Board of Directors approved the proposal to revise facilitated pancreas allocation. This proposal establishes qualifying criteria for transplants centers to participate in facilitated allocation and gives OPOs the ability to make facilitated offers.
There were two changes made to the proposal in response to public comment last Fall. The qualifying criteria was changed from 5 import pancreas transplants in one of the two previous years to 5 within the two previous years. Also, there was a change to programming that will prevent OPOs from using FPA until all local pancreas and kidney-pancreas offers have been declined. This was in response to the regional concern that OPOs would bypass local centers in in favor of using facilitated allocation.
The policy is effective pending programming and members will be notified when programming is nearing completion. Programming is expected to be completed in 3rd quarter 2016.

3. Policy Implementation Dates
Require the Collection of Serum Lipase for Pancreas Donors
Board Approved November 2014
Anticipated programming completion: 3rd Quarter 2016
Collection of Serum Lipase - The proposal makes serum lipase a required field for all pancreas donors. It also creates another required new field, the upper limit of normal serum lipase value. OPOs will have to report serum lipase tests results and the upper limit of normal at the time of the pancreas offer and for all pancreas offers. Programming is anticipated to be complete during 3rd quarter 2016.

4. Committee Projects
Broadened Allocation of Pancreas Transplants Across Compatible ABO Blood Types
Currently awaiting Executive Committee for project approval
Anticipated for Fall 2016 Public Comment
Pancreas Allocation System - 6 Month post-implementation analysis
No change in the rates of recovery of pancreas organs
Increase in regional kidney-pancreas transplants has not caused fewer local transplants
OPOs are going further down the match run to place a KP
Has not interfered with KAS
Maximum allowable BMI for accruing KP waiting time remains 30 kg/m2
Clarifications to KP Blood Type Allocation - This project is undergoing review by the POC committee for approval. Current blood type restrictions on kidney-pancreas allocation prevent clinically compatible SPK transplants from occurring. Preventing clinically compatible SPK transplants results in many of these potential pancreata to be discarded or not recovered otherwise. The Committee intends to revise current blood type restrictions on kidney-pancreas allocation with the goal of increasing the number of simulataneous pancreas-kidney transplants and increase the number of utilized pancreata. Removing blood type restrictions for kidney-pancreas allocation is expected to increase equity in access to candidates across blood types. The Committee will use SRTR modeling to determine the effect of said changes on candidates (specifically kidney-alone and kidney-pancreas candidates).
Pancreas Allocation System - With an increase in deceased donors recovered and number of transplants in the first six months post-implementation, there has not been a change in the rates of recovery of pancreas organs. The increase in regional SPK transplants has not resulted in fewer local transplants and OPOs are going further down the match run to place an SPK. The new pancreas allocation system has not interfered with KAS by removing a larger amount of kidneys available for the kidney list. Additionally, the maximum allowable BMI for accruing waiting, for a kidney-pancreas candidate remains at 30 kg/m2. We are continuing to monitor the effects of this policy change and will provide 1 year data results in Fall 2016.

5. Questions?
Jonathan Fridell, MD Committee Chair Matthew Prentice, MPH Committee Liaison