1. 1 Proposal to Modify Pediatric Lung Allocation Policy Thoracic Organ Transplantation Committee Fall 2015

2. 2 What problem will the proposal solve?  May 2013: HHS requests that OPTN identify opportunities to improve access for pediatric lung candidates  June 2014: Board passes Adolescent Classification Exception  Nov 2014: Board passes Pediatric Ethical Principles  Reviewed current lung policy with goal of increasing equity in access to size-matched organs for pediatric candidates and identified: 1. Alternative blood type matching permitted for hearts, not lungs 2. Broader geographic sharing through Zone B only of child (0-11) donor lungs to child candidates

3. 1. Establish eligibility criteria for alternative blood type matching How does the proposal address the problem? 3 Eligibility criteria Classified with Age (at match)Medical urgencyTiter <1 year oldPriority 1No limitIdentical ABO* ≥1 year old, registered before 2 nd birthday Priority 1≤1:16Compatible ABO *Priority 1 candidates <1 year old that are blood type compatible will be classified with identical blood types.

4. 2. Broader sharing of all pediatric (<18) donor lungs How does the proposal address the problem? 4 Local+Zone A+Zone B Zone C* *Continue to radiate in 500-mile concentric circles through Zone E

5. 3. Prioritize children first (0-11), then adolescents (12-17), for all pediatric donor lungs (<18) How does the proposal address the problem? 5 Donor Age <18 Zone Candidate Age Group Local + Zone A + Zone B0-11 Local + Zone A + Zone B12-17 Local≥18 Zone A≥18 Zone B≥18 Zone C0-11 Zone C12-17 Zone C*≥18 *Zone C sequence continues through Zone E

6.  Proposed changes supported by ethical principles  Alternative blood type matching may:  Improve use of 0-2 year old donor lungs  Improve waitlist mortality among infant candidates  Benefit an estimated 12-14 candidates each year  Modeling for Broader Sharing showed:  Increased transplant rates for 12-17  Trend toward increased rates for 6-11  No negative impact on other age groups Supporting Evidence 6

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8.  Consider listing patients meeting criteria as eligible to accept a blood type alternative organ  Report titers upon indicating that a candidate is eligible and every 30 days after  If available, report titers at transplant and if graft loss or death w/n one year post-transplant How will members implement this proposal? 8

9. How does this proposal support the OPTN Strategic Plan? 9 Supports:By: Broader sharing with child priority Goal 2: Improve accessProviding better access for all pediatric candidates to size- matched lungs Alternative blood type matching Goal 1: Increase transplantsIncreasing use of smallest donor lungs Goal 3: Improve waiting list outcomes Decreasing waitlist mortality among infants

10. Joe Rogers, MD Committee Chair joseph.rogers@duke.edu Regional representative name (RA will complete) Region X Representative email address Liz Robbins Callahan Committee Liaison liz.robbins@unos.org Questions? 10