1. 1 Proposal to Revise Facilitated Pancreas Allocation Policy Pancreas Transplantation Committee Fall 2015

2. 2 What problem will the proposal solve?  Current process only places a small number of pancreata  Addresses decrease in pancreas transplantation by improving facilitated pancreas allocation (FPA) process

3.  Increase pancreas transplants through more effective organ placement by:  Establishing a system in which facilitated pancreas offers are made to those transplant programs readily importing pancreata from outside their DSA  Increasing use of facilitated pancreas allocation by giving OPOs access to it, not just the Organ Center What is the goal of the proposal? 3

4.  Establishes qualifying criteria for programs to participate in facilitated pancreas allocation  The current FPA list is voluntary (only requiring a letter of intent)  Transplant program transplanted at least 5 imported deceased donor pancreata (including multi-organ transplants) in one of last two years = qualifies to receive facilitated offers  The computer programming is already in place, UNOS will just update the list with qualified programs How does the proposal address the problem statement? 4

5.  OPOs and the Organ Center can make facilitated pancreas offers if no pancreas offer has been accepted three hours before the scheduled donor organ recovery  Facilitated pancreas offers are only made to programs that are on the FPA list (meet qualifying criteria) How does the proposal address the problem statement? 5

6.  Of the 31 programs on the FPA list, several have not been importing pancreas transplants recently; and some perform zero import pancreas transplants in a year  There are programs with a high percentage of imported pancreas transplants that are not currently on the facilitated allocation list  Changes mean that the same centers currently on the list might not remain on the list. Using 2014 data, 23 centers would have qualified for FPA, only 11 of which are on the list today.  Would not intrude on normal allocation-OPOs begin pancreas offers on average 19 hours before cross clamp. Standard allocation system would still be the primary method of organ placement. Supporting Evidence 6

7.  OPOs  Option to make facilitated pancreas offers, must follow the match run  Offers can be made within 3 hours of scheduled organ recovery  Pancreas Transplant Programs  Continue to collect, maintain, and submit to the OPTN all records of imported pancreas transplants annually  Data determines which programs are eligible for the facilitated pancreas allocation list for next calendar year  Programs that don’t wish to participate must notify the OPTN in writing How will members implement this proposal? 7

8.  Increase the number of transplants  Enhances the efficiency of organ offers and acceptances by prioritizing programs that, based on past behavior, are more likely to accept and transplant an imported pancreas  Minimize organ discard rates and failed offers, leading to an increase in the total number of pancreas transplants How does this proposal support the OPTN Strategic Plan? 8

9. Jonathan Fridell, MD, FACS Committee Chair jfridell@iupui.edu Regional representative name (RA will complete) Region X Representative email address Matthew Prentice, MPH Committee Liaison matthew.prentice@unos.org Questions? 9

10. 10 Annual Data Program (Encrypted) N Years Qualified from 2010 through 2014 Year N Total Pancreas Transplants N Imported TX in Year N Imported TX in Year 1 Previous N Imported TX in Year 2 Previous Qualified? 002484 2010161135Yes 2011107113Yes 201200711Yes 20132007Yes 20144000No 121523 201016527Yes 20116252Yes 201211325Yes 20139432No 201412243No 165233 201027535Yes 201128453Yes 201232145Yes 201325214No 201424621No 190341 201015000No 201115000No 201227400No 201323640No 201425164Yes 197473 201010235Yes 20116523No 20124152Yes 20130015Yes 20141001No