Industry Literature

Making organ recovery transportation safer for transplant teams

in focus

Despite a decade since a 2007 fatal plane crash involving a University of Michigan transplant team and pilots, there remain no federal standards regulating air and ground transportation of organ recovery personnel.

The American Society of Transplant Surgeons, the American Society of Transplantation, the Association of Organ Procurement Organizations, and United Network for Organ Sharing convened to develop national transportation standard recommendations.

In an article published in the April issue of the American Journal of Transplantation, University of Iowa kidney surgeon David Axelrod, M.D., United Network for Organ Sharing CEO Brian Shepard, and other members of the organ donation and transplant community summarized their discussions and defined national standards for organ recovery practice in three areas: air transportation, ground transportation and insurance coverage.

Recommendation highlights included:

  • Expanding air transport quality assurance protocols, including a requirement for twin-engine, turbine-powered aircrafts piloted by two qualified pilots and operated by organizations that have been certified through onsite inspections
  • Ensuring teams travel in dedicated vehicles with adequate safety restraints; ambulances are avoided whenever possible; and, the use of lights and sirens during transport is minimized
  • Providing adequate insurance coverage for all organ recovery team members, including trainees

New organ allocation policies that mandate broader sharing have highlighted the need to formalize transportation safety protocols as an essential element of the national standards followed by all transplant teams. The organ donation and transplant community members convened in 2008 to develop standards meant to ensure the safety of transplant team members and organ procurement organization personnel who travel to recover lifesaving organs.

Read the abstract

Axelrod DA, Shah S, Guarrera J, et al., Improving safety in organ recovery transportation: Report from the ASTS/UNOS/AST/AOPO transportation safety summit. Am J Transplant. 2020;00:1–8. doi:10.1111/ajt.15930

In focus


Jul 1, 2020 | In Focus, News

Despite a decade since a 2007 fatal plane crash involving a University of Michigan transplant team and pilots, there remain no federal standards regulating air and ground transportation of organ recovery personnel.

The post appeared first on UNOS.

COVID-19 pandemic ignites collaboration in the transplant community

in focus

UNOS collaborated with nine global transplant organizations and societies on four COVID-19 organ donation and transplant town hall webinars that have received more than 25,000 views.

Organ donation and transplantation organizations acted swiftly to produce town hall-style webinars.

As COVID-19 cases began increasing globally, conversations among health care providers about the pandemic’s potential impact on transplant started to emerge.

Within a few days, organ donation and transplant communities from around the world assembled to collaborate on a webinar series sharing real-world, global experiences for the organ donation and transplant community. Along with United Network for Organ Sharing, participating organizations included:

The societies launched their first live, collaborative webinar “COVID-19: Organ Donation and Transplant Town Hall,” on March 23, and the 1,000 available seats filled up within a few hours. Collaboration continued over the following weeks with three additional webinars, covering topics ranging from:

  • Presentation, diagnosis, treatment and prevention
  • Getting to transplant
  • Operational issues
  • Screening donors and candidates
  • Protecting the workforce
  • Ethical issues

The societies aren’t done yet, with future plans to produce more collaborative webinars on navigating COVID-19, as well as topics unrelated to the pandemic.

Read more about the COVID-19 pandemic and collaboration within the transplant community.

In focus


Jun 16, 2020 | In Focus, News

Organ donation and transplantation organizations acted swiftly to produce town hall-style webinars that have been viewed more than 25,000 times.

The post appeared first on UNOS.

How the COVID-19 pandemic spawned collaboration in the transplant community

A Q&A with American Society of Transplantation immediate-past president Emily Blumberg, M.D.

“I would have never foreseen the incredible positive force that such a collaboration could generate. I think it all made us feel we were doing something important for the community.”
Emily Blumberg, M.D., immediate-past American Society of Transplantation president

As COVID-19 cases began increasing globally, conversations among health care providers about the pandemic’s potential impact on transplant started to emerge. “This sense of the need to educate our communities—both individually and potentially as a group—came up, and we started sending around emails amongst ourselves,” said transplant infectious disease specialist Emily Blumberg, M.D., who recently served as president of the American Society of Transplantation.

Within a few days, organ donation and transplant professionals from around the world had assembled to collaborate on a webinar series sharing real-world, global experiences for the organ donation and transplant community.

“COVID-19 presented a unique opportunity for us to convene not only transplant associations in the United States, but across the world,” said former UNOS Board of Directors president Stuart Sweet, M.D., Ph.D., who recently concluded his term as president of the International Society for Heart and Lung Transplantation. “It was really taking advantage of a challenging opportunity to convene our community in a way that we’d never done before.”

Registration for the first live, collaborative webinar “COVID-19: Organ Donation and Transplant Town Hall,” launched on March 23 and the 1,000 available seats filled within a few hours. Collaboration continued over the following weeks, with three additional webinars covering topics ranging from protecting the workforce to conversations around testing. Collectively, the webinar recordings have been viewed more than 25,000 times.

In a recent interview, Blumberg talked about how the organ donation and transplantation community united amidst the COVID-19 pandemic to launch the webinar series.

How did the idea for the collaborative COVID webinars come to be?

I’ve been thinking back about how this started and honestly, I think there were a lot of side conversations that happened among leadership of these different organizations. But somehow, organically, this sense of the need to educate our communities—both individually and as a group—came up, and we started sending around emails amongst ourselves. All of a sudden we had a group of committed individuals who thought that we should try to share information in real time. There was tremendous brainstorming about speakers at every juncture and how to make it international. I think people were just really interested in helping to meet the challenge of COVID with information to the best of our ability in real time.

The town hall webinars are a collaborative effort between:

What was the goal?

The first goal was to disseminate current information from people who were already experiencing the management of transplant patients with COVID-19. We wanted to have people who could give us real world experiences and who would have a perspective to help pave a way for everybody else to start thinking about it. One of the incredible things about the webinar was having the international components provided by several of the societies. Especially with everything that has gone on in Italy, ahead of us, in terms of experience. We could actually engage people who knew a little bit more about what they were seeing and how they were handling it and get some real-time, practical information. I think this is something that would never have been doable if we had tried to stay local.

How did everything come together?

On our first call, we were brainstorming about different topics that people were interested in hearing about and that we thought would be helpful, and where different members of the societies were experience-wise. We made an enormous list of these. Then we pared the list down and tried to make it into a cohesive whole. We really benefited a lot from UNOS their willingness to use their platform. Because UNOS had the technology already set up, that became an immediate weight off everybody’s shoulders about how we were going to do this. It also took out of any individual society’s purview, which I think helps the collaboration and made it easier. We asked everyone to come in with three really relevant slides and five minutes of critical information. It really focused the individuals and allowed us to bring many more viewpoints.

What was the experience like working with so many societies?

I don’t think anybody, at any point, saw this as owned by any individual society. I think we all appreciated what all the different societies had to contribute and their commitment to it. It’s an extraordinary group effort. Personally, I knew some of the people involved in advance of the webinars, but there were people I’ve met through this experience who it’s been such a pleasure to collaborate with. I think that could be said for all of us.

What surprised you most about the collaboration?

I’ve been impressed by how engaged people have stayed throughout the entire process. It wasn’t like the first one was done and everybody checked out. We realized people were really interested and it made people engaged in doing another one. When we did the second one and the extra module for it, we said, “Wow, people are still interested.”

How do you think this collaboration has helped the transplant community as they navigate COVID-19?

We’re all benefiting from learning from everybody’s experience for sure. I mean, there have been some difficult times for all of us. Having this information to fall back on has been really beneficial. Just in our day-to-day jobs in taking care of patients, setting up things in our various transplant hospitals and trying to learn from people’s experience so you’re not starting at the bottom. You’re actually starting with the foundation that you’ve gained from interfacing with people throughout the world.

What do you hope the community has gained from these events?

I think we’ve gotten to know one another a little better and feel more globally joined as a community, in a way that maybe we didn’t feel so much before. The societies have interacted one-on-one with other societies on certain initiatives, but this experience let us know that people are interested in a bigger world. Not that the societies individually are going away, but that they’re finding new ways to collaborate and we’re all learning from one another.

What’s your hope for the future?

I’ve talked individually with some of the other leaders of other societies and I think we would like to try to continue some level of international education. I hope that we’re going to be able to talk in the next week or two to figure out what our next steps are going to be. I think it would be nice to expand this tent to include more people.

This was one of the most exciting things that I’ve gotten to participate in during this past year. I would have never foreseen the incredible positive force that such a collaboration could generate. I think it all made us feel we were doing something important for the community. We all had a common goal and a common interest and it was really a pleasure.

The post appeared first on UNOS.

COVID-19 updates: April 24, 2020

Patient Q&A with UNOS Chief Medical Officer David Klassen

Navigating the coronavirus pandemic is difficult for everyone, but brings special challenges for transplant patients. In a new video series on TransplantLiving.org, UNOS Chief Medical Officer David Klassen, M.D., answers questions for patients about COVID-19 and the waiting list, temporary inactivation, donor testing, living donation and other important topics.

Reactivation process for multiple kidney transplant candidates now available

As of April 22, kidney transplant programs are now able to simultaneously perform reactivation of multiple candidates whose current status is “Temporarily Inactive (7),” with inactive reason “COVID-19 Precaution.” Details and directions were sent via email to staff at all kidney transplant programs and posted on Secure Enterprise. In addition, step-by-step instructions are available in online help in UNetSM.

Programs also have the ability to perform temporary inactivation of multiple transplant candidates simultaneously for the reason of “COVID-19 Precaution,” which was released March 27. Together, this set of tools ensures offers are made efficiently to candidates who are immediately eligible for a transplant and streamlines the offer process.

Before temporarily inactivating candidates, please reference OPTN policy 3.6.A for information about whether candidates needing a particular organ type accrue waiting time while inactive.

ISHLT presents new webinar: COVID-19 and challenges in advanced heart and lung disease and cardiothoracic transplantation

The International Society for Heart and Lung Transplantation is holding a free, live webinar for the cardiothoracic transplant community on April 29 at 4 p.m. ET. A recording will be posted for later viewing. Membership is not required and CE credit is available.

UNOS Staffing Survey deadline extended through Dec. 31

The deadline for the UNOS 2019 staffing survey has been extended from May 31 to Dec. 31. The extension is in response to the COVID-19 pandemic and will ensure maximum participation from as many hospitals as possible.

Reminders

COVID Collaborative now open for registration

The OPTN launched an interactive forum on April 22 so that members may engage on topics specific to donation and transplant during COVID-19. The OPTN COVID Collaborative operates on a secure online communication platform and allows donation and transplant professionals to collaboratively discuss, organize, catalog and archive the learnings and insights developed during the 2020 pandemic.

The site will:

  • Offer discussion forums, facilitated by collaborative improvement specialists
  • House and organize the member-driven information that results from this collaboration
  • Be available for the duration of COVID-19, or until the decision is made to close the project
  • Deploy national and regional webinars to support the spread of effective practices that emerge from site discussion

Participation in the COVID Collaborative is limited to individuals from OPTN member organizations. Registration is required. The scope of discussions will include OPTN member business and administrative processes related to the management of COVID crisis, and discussions will be moderated. Members with questions about policy during the pandemic should email member.questions@unos.org. Members with questions about policy compliance during the pandemic should email MQFeedback@unos.org.

Members may register here. Participants will receive an email with account and login information within two business days of registering.

For more information about the OPTN COVID Collaborative, email covidcollab@unos.org

Temporary changes to transplant program member monitoring as a result of the pandemic

MPSC leadership has evaluated specific areas of monitoring that are raising particular concern within the community. In an effort to encourage transplant programs to use their clinical judgement about what is in the best interests of their patients without the added concern of strict compliance with OPTN obligations, the MPSC will implement several time-limited emergency changes to member monitoring. These include:

  • Suspending functional inactivity reviews through Sept. 30
  • Placing a temporary hold on reviews of patient notification of extended waiting list inactivity and transplant program inactivation through Sept. 30

All time-limited COVID-related updates to monitoring changes may be found in a supplement to the OPTN member evaluation plan on the OPTN Compliance page. This document serves as a quick-reference guide to all member monitoring changes implemented as a result of the pandemic. It will be regularly updated with any additional monitoring changes implemented during this event.

Site surveys

Site surveys will be conducted virtually at least through the end of June. Any member who is not able to participate in a survey at this time can request a delay by emailing MQFeedback@UNOS.org

Patient safety portal reporting

Remember to report any suspected transplant-related disease transmissions through the Patient Safety Portal. At this time, the major transplant societies (AST, ASTS, AOPO, TTS) recommend against transplanting organs from a donor who has tested positive for COVID-19 from a respiratory tract sample or the blood, as this is likely indicative of an active infection that could be transmitted to a recipient, organ procurement team, transplant team or other contact.

New resources

Stay current

We will continue to update the UNOS COVID-19 resources page as guidance is developed and enhanced.

The post appeared first on UNOS.

Updates to OPO notification limits for electronic notification for heart, lung, and heart-lung matches

Audience

  • OPO directors, administrators, data coordinators and clinical coordinators
  • Please share this notice with anyone in your organization who would benefit from this information.

Implementation date: April 6, 2020

Updates for electronic organ offer notifications provide additional efficiency and flexibility about how to offer organs

An update has been made for OPO electronic organ offer notification limits in DonorNet® to provide additional efficiency and flexibility to make informed decisions about how to offer organs using their own defined best practices. Revised heart and lung policies no longer use the donation service area (DSA) as the first unit of allocation, and therefore candidates at the top of the match runs may include potential recipients who are beyond the DSA border.

What you need to do

Directions were included in an e-mail sent April 6 to all OPOs and are posted in a system notice in Secure Enterprise.

 Additional resources

DonorNet® online help documentation has been updated so that OPOs will have access to the information about how local limits are used for heart, heart/lung, lung and liver matches.

Questions?

If you have questions relating to implementation, contact UNOS Customer Service at unethelpdesk@unos.org, or call 800-978-4334 from 8 am to 7 pm EST.

For policy-related questions, contact member.questions@unos.org or call 844-395-4428.

The Organ Center is available around the clock and can be reached at 800-292-9537.

The UNOS COVID-19 resources page is refreshed regularly with the most current updates and resources. Please check back frequently for updates

 

 

The post appeared first on UNOS.

COVID-19 updates: April 1, 2020

UNOS, ASTS, AOPO and AST all urge local recovery of organs

The donation and transplant community has expressed unified support for the surgical recovery of organs by local teams. UNOS, ASTS, AOPO and AST released statements regarding this important step in reducing exposure to COVID-19, safeguarding the health of clinicians and facilitating the continuation of organ transplant in this challenging environment.

UNOS

“To protect the health and safety of all involved in organ recovery and transplantation during the COVID-19 pandemic, UNOS urges members to arrange for the surgical recovery of organs by local teams whenever possible, including by recovery surgeons who may be available within the donor hospital.”

ASTS

“The best way to prevent COVID-19 spread by a donor organ recovery team is to AVOID TRAVEL BY THE TEAM. ASTS strongly recommends that local teams be requested to recover organs and ship them to the recipient center for transplantation.”

AOPO

“AOPO urges OPOs to arrange for the surgical recovery of organs by local teams whenever possible consistent with the recent statement and the CMS requirements for the approval of recovery surgeons and the AOPO Standard for Surgeon Qualifications. This would include prioritizing the use of recovery surgeons that may be available within the donor hospital.”

AST

“ that it is in the best interest of organ donation and transplant team members to limit the recovery of organs to local teams, unless there are extenuating reasons for the transplanting team to perform the recovery.”

New option to report cause of death for transplant candidates and recipients

A new cause of death code, “Infection: Viral – Covid-19,” has been added to WaitlistSM and TIEDI® to allow transplant program staff to more accurately report data. This new code will allow for better assessment of the impacts of the COVID-19 pandemic on transplant candidates and recipients. Process directions were emailed April 1 to staff at all transplant programs and posted in Secure Enterprise.

SRTR extends data review period deadline from April 30 to May 31

In light of the COVID-19 pandemic, SRTR is extending the Data Review Period deadline from April 30 to May 31. This allows transplant programs and OPOs more time to review their data for accuracy during this difficult time. Given the rapidly evolving situation, the deadline may be extended again in the future, and SRTR will work closely with HRSA and OPTN leadership to make that determination. Data Integrity Reports and program-specific report drafts for transplant programs and Donor Level Data sheets and OPO-specific report drafts for OPOs are available to review from April 1 to May 31, until 11:59 PM EDT. Verify data and make changes in UNet or DonorNet®. UNOS, the SR and HRSA are discussing modifications to the performance metrics contained in the program-specific and OPO-specific reports and will share more information as it becomes available.

New resources

Stay current

We will continue to update the UNOS COVID-19 resources page as guidance is developed and enhanced.

The post appeared first on UNOS.

Differences in Metabolic Profiles of Human Hearts after 6 Hour Preservation with a Novel Hypothermic Machine Perfusion Preservation Device Compared to Cold Storage

While cardiac transplantation remains the most effective therapy for end-stage heart failure, it continues to be plagued by a severe donor shortage. Many potentially suitable organs are not transplanted due to concerns of inadequate preservation with hypothermic static storage. Experimental and clinical studies suggest that machine perfusion preservation improves myocardial preservation. The purpose of this study is to test the hypothesis that a novel hypothermic machine perfusion preservation device maintains allograft oxidative metabolism, limits lactate accumulation, and more effectively preserves high energy phosphate stores compared to cold storage in a human model.

Minimizing Cardiac Oedema during Ex Vivo Perfusion in a Juvenile Porcine Model – How Much Does Coronary Flow Matter?

Transmedic Organ Care System (OCS) allows preservation of the donor heart by perfusing the organ at 34°C in a beating state and providing additional assessment options. The perfusion protocols as established by the manufacturer is valid for adult human hearts, using coronary flows in the 8-900ml/min range guided by lactate measurements. Higher flow can facilitate higher degrees of cardiac oedema which can be associated with diastolic dysfunction, and generel impairment of contractility of the heart.

Ex Vivo Organ Perfusion for Heart Procurement in High-Risk Transplantations: A Multicenter Study

Ex vivo heart perfusion is an innovative preservation technique, that permits graft assessment and extended out-of-body intervals. In times of high-risk recipients and donors with extended criteria, we hypothesized that its properties for prolonged heart preservation might be especially beneficial.

Eight-Hour Ex Situ Perfusion with Functional Assessment of an Adult Heart after 12 Hours Hypothermic Preservation: A Case Study

Ex situ heart perfusion (ESHP) allows resuscitation and functional assessment of marginal donor hearts to expand the donor pool. The current clinically available ESHP platform does not enable contractile assessment. We sought to determine if a marginal donor heart could be resuscitated and assessed on our custom ESHP system following an extended period of cold storage.