1. OPO Allocation Protocol Reduces Cadaveric Kidney Cold Ischemic Time
John Abrams; Lawrence Suplee; Howard M. Nathan;
Richard Hasz; Sharon West
 Gift of Life Donor Program, Philadelphia, PA
Presented by:
Lawrence Suplee
Candles with the Obelisk of Buenos Aires in the background
The Puente de la Mujer (Spanish for "Woman's Bridge") is a footbridge in the Puerto Madero district of Buenos Aires, Argentina
Building in La Boca
GLDP
2011 ORGAN DONATION CONGRESS

2. Gift of Life Donor Program Philadelphia, Pennsylvania USA
Non-Profit OPO/Tissue Recovery/Eye Bank
Established in 1974
Federally designated OPO (by Medicare) for eastern PA, Southern NJ & Delaware Acute Care Hospitals
15 Transplant Centers, 43 Programs
10.3 Million Population
2011* Projected Data:
- 440 Organ Donors / 42.7 Donors/MM
- 1,236 Bone Donors and 2,551 Cornea Donors
Over 31,000 organs for transplantation and over 375,000 tissue allografts
Accredited by: Association of Organ Procurement Organizations (AOPO); American Assoc. of Tissue Banks (AATB) & Eye Bank Assoc. of America (EBAA); UNOS/OPTN member OPO
Sharon- Update slide based on projections, previously discussed.
Sharon- updated projections
Projected 2011: Organ donors-438; Bone donors-1232; Tissue donors-2710; Eye Donors: 2551;
*Source: Gift of Life data Projection Based on YTD performance through 11/15/2011 2

3. Introduction & Purpose
Give Away
Transportation
Final XM
TXP
Allocate
HLA
List
Cold Ischemic Time
Renal Distribution Time
Transplant Center Time
Renal Distribution Time (RDT)
(OPO driven)
RDT is defined as the time from cross-clamp to when a kidney is available to a center for a specific recipient including complete donor history and compatible final crossmatch.
Transplant Center Time (TxT) (Center driven)
TxT is defined as the time a center requires to implant the kidney from renal distribution time.
Format arrows, etc. Then a pop up text box with definition of RDT and then a second one that defines
Add transportation time to big arrow after give away time
Explain- local to local (exclude ex renal and exported)
Time needed to determine donor HLA & recipient suitability (compatible final crossmatch) present challenges to reducing cold ischemic time (CIT).
. Prolonged CIT is a significant predictor of long-term graft failure (1)
CIT is a combination of:
Renal Distribution Time (RDT) (OPO driven)
RDT is defined as the time from cross-clamp to when a kidney is available to a center for a specific recipient including complete donor history and compatible final crossmatch.
Transplant Center Time (TxT) (Center driven)
TxT is defined as the time a center requires to implant the kidney from renal distribution time.
Transportation time is responisiblity of OPO- we do all we can to make sure KI is at TXC as quickly as possible after acceptance

4. Improving Renal Distribution Times
HLA identification process starts using peripheral
blood immediately after family consent
Blood routinely sent to all local HLA Labs
Improving Renal Distribution Times
Specialized OPO renal allocation staff initiate
kidney distribution
Final crossmatches performed by all local
Transplant Centers
Animate so one box comes up at a time
Can we make the “Improving Renal Distbutinon times” across the top or bottom?
What is average time from consent to clamp? hours??
Discuss how many times a year we do this.
We monitor local donors/local transplants (exported kIs and kis placed with ex-renal are not included).
15 transplant centers and 8 HLA labs
Couriers alerted and present at donor hospital
to transport kidneys to accepting center

5. Results: Renal Distribution Times (RDT) 2006 to 2010
Format- make bigger
Comment on DCD- why here
Explain DCD, ECD, SCD,
Define Factor SCD (those at risk for disease transmission)- positive seros, any history of CA, positive blood cultures, high risk social, hemophilia

6. ECD Median Times (Hours) 2006 – 2010

7. SCD Median Times (Hours) 2006 – 2010

8. Local SCD Kidney ATN Rates by CIT 2006 – 2010

9. Local ECD Kidney ATN Rates by CIT 2006 – 2010

10. Conclusion
OPO re-design of core process for renal allocation reduced median CIT by
SCD by 3 Hours 23% (actual time)
ECD by 1.8 Hours 14% (actual time)
OPO reduction in renal distribution time (RDT) by:
61% (SCD) to 2 hours
39% (ECD) to 2.8 Hours
Median TxT (from 15 centers) varied by center from ’ 44” to 8’ 54”
Transplant centers should examine their practices after accepting a kidney to ensure lowest possible CIT
OPOs should measure RDT to improve kidney allocation
Update % for CIT and historical levels
LFS- add something about the quality piece…and reduction of CIT….

11. Comments?
QUESTIONS?
For correspondence