1. OPTN OPTN Kidney Paired Donation Pilot Program Ruthanne L Hanto RN, MPH Program Manager, OPTN KPDPP Regions 4 Meeting May 11, 2012

2. OPTN Discussion  Data  Guidelines and Proposed Policy  OPTN KPDPP Process  Integration with UNet SM  How to join  Webinar information  Questions

3. OPTN DATA

4. OPTN Transplant centers who had preformed at least 1 KPD transplant in the U.S. Segev, D KPD Consensus Conference April 2012 Dulles + HI

5. OPTN http://optn.transplant.hrsa.gov/latestData/rptData.asphttp://optn.transplant.hrsa.gov/latestData/rptData.asp Living Donor Transplants By Donor Relation Based on OPTN data as of March 30, 2012

6. OPTN Transplant centers participating in the OPTN KPDPP  118* Transplant centers  11 Regions *As of May 9, 2012

7. OPTN Candidate and Donor Characteristics May 3, 2012 Match Run CharacteristicCandidates Donors Total150 167 (5 NDD) Blood Type O67.3% (101) 32.3% (54) CPRA ≥ 80%56.7% (85) Willing to travel to matched center7.3% (11) 32.3% (55) Willing to ship/accept a shipped kidney from/to any center 92.7% (139) 97.0% (162)

8. OPTN Total transplants and pending transplants to date

9. OPTN GUIDELINES/ PROPOSED POLICY

10. OPTN Why is the OPTN a Pilot Program?  To work out the logistics of KPD prior to setting policy  Currently participating transplant centers abide by Guidelines  Guidelines converted to public policy – proposal out Spring 2012

11. OPTN Starting your KPD Program  Identify key personnel  Put processes in place  Get the word out to your patients  Identify potential KPD pairs

12. OPTN OPTN Bylaws Requirements  Approved living donor kidney program  Notify OPTN Contractor in writing  Provide primary and secondary KPD contact OPTN KPDPP Agreement to Participate

13. OPTN Requirements for Participation  Candidate On waiting list  Donors 18yo or older Listed in KPD only once

14. OPTN OPTN KPDPP Required Consents  Agreement to Participate Form (separate)  Donor Education Documentation Forms  Candidate Education Documentation Forms  Authorization for Disclosure of Medical Information – HIPPA (no template – yet)  Accepting/shipping a living donor kidney

15. OPTN Data Requirements  Donor & Candidate meet requirements for donation and transplantation  Required R data fields & Eligible* data fields  Tissue typing requirements  ABO verification  A 2 and A 2 B matching  Donor and Candidate choices

16. OPTN Required Policies  When/how matched donors and candidates can meet (communicate)

17. OPTN PROCESS

18. OPTN Match Run Announcement

19. OPTN Match Run Announcement

20. OPTN Match run schedule posted Data entry deadline Eligibility reports emailed date – May 24 th in UNet SM Match run date

21. OPTN Match Run  Twice/month

22. OPTN Types of KPD

23. OPTN Donor Chains

24. OPTN Prioritization Points Priority Points Per Candidate Base match per candidate (based on 200 points for a 2-way match)100 points Zero antigen mismatch with the matched donor200 points Highly sensitized candidate (CPRA ≥80%)125 points Prior living donor status of the candidate150 points Pediatric candidate (age <18 years)100 points Waiting time accumulated within the KPD program 2 points per match run Geographic proximity with the matched donor (i.e. transplant center, local, regional) 75,50,25 points, respectively Candidate’s other antibody specificities present in donor-5 points

25. OPTN Edge Weights 525325 675

26. OPTN Match offers Final acceptance deadline

27. OPTN Finances KPD Financial Recommendations KPD Financial Checklist KPD Financial Memo

28. OPTN KPD Logistics  2 & 3 way exchange same day  Chains sequential  Candidate receives kidney before donor donates  Donor nephrectomy schedules within 3 weeks of paired candidate’s transplant

29. OPTN KPD Logistics Transporting Kidneys  Chain of custody for shipping kidneys  UNOS works with center, OPO, courier in setting up transportation

30. OPTN “Every system is perfectly designed to get the results it is getting” - Don Berwick

31. OPTN Process Improvement  Increase the number of match runs  Decrease matches declined due to HLA issues  Allow Bridge Donors in the system  Decrease matches declined due to inactive pairs

32. OPTN Process Improvement  Increase the number of match run 1x – 2x/month  Decrease matches declined due to HLA issues HAC Donor pre-select  Allow Bridge Donors in the system Proposal out for public comment for bridge donors  Decrease number of decline due to inactive pairs Education Eligibility in UNet SM

33. OPTN Automated Solution Released in Phases  Data entry  Eligibility reports  Donor pre-select  Display of match offers  Tracking of matches,acceptance,refusal  View matched donor information  Logistics sheet  Contact information  Match communication blog

34. OPTN Unique to OPTN KPDPP  Transparency & Oversight  Priority Points – consistency in matching  Fully automated computer system integrated with UNET™  No additional OPTN or UNOS fees

35. OPTN HOW TO PARTICIPATE IN THE OPTN KIDNEY PAIRED DONATION PILOT PROGRAM (KPDPP)

36. OPTN Entering Pairs in OPTN KPDPP  Center signs agreement  Center activated in UNet™  Site administrator grants staff access  Enter pairs OPTN KPDPP Agreeme nt to Participat e

37. OPTN Demystifying the OPTN Kidney Paired Donation Pilot Program  KPD Basics Recording Available  Guidelines to KPD Finances: Who Pays for What Recording available  Unacceptable antigens in KPD June 20 th 2:00 – 3:00 PM ET  Navigating the Logistics of KPD July 25 th 2:00 – 3:00 PM ET A B DR DP DQ

38. OPTN Everything you want to know about the OPTN KPDPP http://communication.unos.org/2012/02/everything-you-wanted-to-knowaboutthe-optn-kidney- http://communication.unos.org/2012/02/everything-you-wanted-to-knowaboutthe-optn-kidney-