Industry Literature

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.

COVID-19’s impact on organ donation and transplantation discussed at multi-society webinar

Organ donation and transplant professionals from around the world convened on March 23 in a town hall webinar aimed at helping health care professionals navigate the ever-evolving COVID-19 health crisis. “Our goal was to share our experiences to date and respond to questions about the impact of COVID-19 on organ donation and transplantation,” said Shandie Covington, Chief Executive Officer of the American Society of Transplantation (AST) who worked with colleagues from nearly a dozen organizations to produce the free live webinar for 1,000 organ donation and transplant professionals across the country.

A recording of “COVID-19: Organ Donation and Transplant Town Hall” is now available online.

Welcome and Introduction – Emily Blumberg (AST)

COVID-19: Presentation, Diagnosis, Testing, Treatment, and Prevention – Moderator: Deepali Kumar (AST)

  • Background/Disease Presentation – Erika Lease (ISHLT)
  • U.S. Cases – Ajit Limaye
  • Immunosuppression management in COVID+  – Attilio Iacovoni (ESOT)
  • Antivirals and Immunomodulators – Paolo Grossi (ESOT)
  • Prevention (infection control) – Marian Michaels (AST)
  • Pediatrics – impact on this population  –  Lara Danziger-Isakov (ISHLT)

Getting to Transplant: Donor Issues and Candidate Concerns – Moderator: Lloyd Ratner (ASTS)

  • Getting to transplant
    • Donor issues/screening and testing platforms – Mike Ison (TTS)
    • Procurement strategies – special safeguards needed for HCW, OPO and surgeon – Ajit Limaye, Kevin O’Connor (AOPO), Kelly Ranum
  • Candidate concerns – managing the organ offer – Luciano Potena (ESOT)

Operational Issues (In-House and Managing Patient Concerns) – Moderator: Maryl Johnson (UNOS)

  • Operational Issues
    • Working with the institution to function during a pandemic – scaling back services, patient cohorting, logistics, determining resource sharing – Atul Humar (CST), Luciano Potena (ESOT)
    • Managing patient and family concerns, 90-day medication supply – Stacee Lerret (NATCO)
    • Practical approaches to visits off-site (telemedicine, etc.) – Lewis Tepermann (ASTS)

Next steps: Data Collection and Sharing – Moderator: Stuart Sweet (ISHLT)

  • Next steps
    • Data collection – the need to collect data and better understand what we are seeing – Tim Pruett (ASTS)
    • Clearing peer review to get information into journals efficiently – Allan Kirk (AJT)

 Closing and Resources: Emily Blumberg (AST)

  • Available Resources
  • Refreshing resources as new information is established
  • Closing Thoughts

The town hall webinar was a collaborative effort between:

For more information about COVID-19, including advice from the Centers for Disease Control and Prevention, the Organ Procurement and Transplantation Network, and other sources, please visit UNOS’ COVID-19 resources page. The page will be refreshed regularly with the most currently available information.

The post COVID-19’s impact on organ donation and transplantation discussed at multi-society webinar appeared first on UNOS.

Call for nominations for OPTN Heart Committee and Lung Committee

The Organ Procurement and Transplantation Network Board of Directors has approved replacing the OPTN Thoracic Organ Transplantation Committee with two separate committees – a Heart Transplantation Committee and a Lung Transplantation Commiteee.

The new committees will begin their work on July 1, 2020 and will allow the OPTN to be more representative and responsive to the community’s needs, which will in turn help patients.

There is an immediate need to fill a number of positions on the Heart and Lung Committees. Committee members are volunteers, representing a variety of professional disciplines, personal experience and expertise in organ transplantation.

United Network for Organ Sharing as the OPTN values diversity and strives for a Board and Committee system that represents the community we serve. Therefore, members may be donation or transplant professionals, transplant candidates or recipients, living donors, donor families, and/or members of the general public.    

  •  If you wish to be considered for a Heart Transplantation Committee or Lung Transplantation Committee volunteer position beginning July 1, 2020, complete the online Biography Form no later than March 25, 2020.
  • Please note: in the Biography Form under “area(s) of interest” you must select “Thoracic Committee” in order to be considered.  Applications received after this date are not guaranteed review for the coming cycle.
  • To update a previously submitted Biography Form, follow these instructions.
  • To learn about volunteer responsibilities and the selection process, visit the Get Involved page.
  • If you have questions about your application, please contact volunteer@unos.org.

Find information about serving on committees, and details about current openings on the Heart Transplantation Committee and the Lung Transplantation Committee on the OPTN website.

Please contact Sara Rose Wells, Transplant Community Administrator, at sararose.wells@unos.org with any questions.

The post appeared first on UNOS.

Using data to save lives: Neelam Singh on UNOS business intelligence

Business intelligence, or BI, is the process of transforming data into meaningful information. Some organizations use these insights to make decisions to improve performance and reduce operational costs, but in transplantation — when data literally has the power to save lives — its value is beyond measure.

The BI and data products team I lead at United Network for Organ Sharing works with the organ donation and transplantation community to build effective, efficient and user-friendly data tools that help members better navigate transplant’s many challenges. To do this, we need to have an in-depth understanding of not only data but also complex policy specific to different organs. We want to empower users to make optimal use of the information available to them.

BI and data products team (left to right) Adam Bacigalupo, Neelam Singh, Tim Baker and Read Urban.

The data tools we build provide performance indicators, operational metrics and comparison analyses that can assist transplant programs in identifying problem areas. This helps them make better decisions. A number of our efforts right now are focused toward helping transplant programs find anomalies in their data. If we help them make corrections at the right time, the data can increase a patient’s chance of finding the right organ.

We also partner with other UNOS departments like Member Quality. Connecting with and training site surveyors offers us an opportunity to cultivate other data tool learning opportunities for members, which is invaluable.

We are making improvements to existing visual analytics tools such as the kidney waiting list management tool and the living liver donor follow-up report. My team is always thinking about usability and clarifying the objectives of these tools. Even a seemingly subtle change like adding a separate documentation tab can be a significant enhancement for users.

Everyone in the donation and transplant community will tell you that managing data through information technology is at the heart of the work. It’s how people save lives every day. So it’s exciting to get the community involved in these changes — that collaboration is what helps us do our job, which is ultimately to save lives by increasing transplants.

The business intelligence team is eager to work directly with members while developing products and revamping the existing catalog. To submit feedback on any of the data portal tools, or to submit ideas for new tools, please email dataportalfeedback@unos.org. 

Neelam Singh joined the UNOS Research Department in 2019 as manager of the BI and data products team. While earning her MBA in finance from Goa University in India, she had the opportunity to study abroad for a semester at Technische Hochschule, an applied sciences university in Ingolstadt, Germany. This blend of technical ability and business insight has uniquely prepared her for a career in business intelligence. She brings to UNOS more than 10 years of health care data management experience, including building and implementing quality data marts, developing business intelligence capabilities, providing data solutions, designing data process roadmaps and leading standardized reporting projects.

 

The post appeared first on UNOS.

“An Expedia for organ transplantation”

New project aims to better predict organ travel time.

Airplanes making heart path

In the past ten years, more than 45,000 organs recovered for transplantation were not used to save lives, according to data from the Organ Procurement and Transplantation Network.

Part of the organ discard rate can be attributed to prolonged cold ischemic time, which is the time that an organ spends outside the body between procurement and transplantation. “Cold ischemic time not only limits how far an organ can travel, it is also linked with higher rates of organs being declined by transplant hospitals,” said United Network for Organ Sharing data science manager Andrew Placona. Each organ possesses its own cold ischemic time limit. While kidneys can typically survive outside the body for 24 to 36 hours, livers, intestines and pancreata only last on average for about 12 to 18 hours. Hearts and lungs have even shorter cold ischemic time limits, typically lasting outside the body for four to six hours on average.

“Speedier transportation will result in more organs transplanted, more lives saved and more improved long-term outcomes for transplant recipients,” explained Placona, who is serving as principal investigator on research that aims to help organ procurement organization, or OPO, professionals make more informed decisions about optimal travel routes for procured organs.

A joint effort

Partnering with seven OPOs across the country—along with the travel companies they enlist to help transport organs—Placona’s team is conducting real-time data analysis to refine a feasibility algorithm aimed at predicting the optimal route for organ transplantation.

Describing the algorithm as an Expedia-like application that OPO and transplant hospital professionals can use to choose the best route for an organ, Placona said he envisions people using the application to make informed decisions about optimal travel methods for organs and then tracking the organs in real time as they make their way from the donor hospital to the transplant hospital.

“This project addresses a complex problem in organ transplantation, mainly coordinating logistics for organ transport and understanding the components of cold ischemic time,” said Jeffrey Orlowski, president and CEO of LifeShare Transplant Donor Services of Oklahoma, which is the organ recovery organization for the state of Oklahoma.

Beginning December 2019, the UNOS information technology team began assessing the feasibility of building application programming interfaces that will act as bridges between the OPOs’ transportation vendor databases and UNOS’ systems to enable the flow of data between the applications. The feasibility study will continue through August 2020.

The other portion of the project involves analysis to determine if the collected data can contribute to the existing feasibility algorithm, which combines major airline and limited charter availability with current drive times to potentially determine the most efficient travel options at any given moment. The research is being conducted through UNOS LabsSM, which is an experimental incubator that unites data, technology and industry expertise to test transformational ideas and hypotheses for improving the transplant system.

“With a better understanding of how transit time impacts cold ischemic time, we could potentially assign an estimated cold ischemic time upon arrival into UNet,” explained Placona. UNetSM is UNOS’ electronic network that allows transplant professionals to register transplant candidates on the national organ waiting list, match the candidates with donated organs and enter vital medical data on candidates, donors and transplant recipients. “This would allow for more informed organ offer considerations.”

Using big data to solve complex problems

In the future, the research team plans to expand the algorithm to incorporate additional data inputs, such as weather, flight cargo limits and expanded charter flight availability. They also plan to validate the model using previously planned organ travel information, collaborating with courier services and OPOs. After validating the model, UNOS will create a user-friendly application that will enable piloting of the algorithm with more OPOs.

“In our line of work, time is critical and lives depend on timely response,” Orlowski said. “This project explores solutions to organ transportation and will help optimize travel and troubleshoot for weather, traffic and flight changes in real time.”

Placona expects the project to eventually result in reduced prolonged cold ischemic time and enable better transplant outcomes, including reducing organ discards and rejections. “Ultimately, our goal is to increase organ utilization and improve outcomes for patients,” he said. “If we can use data science to figure out where the inefficiencies are in the organ procurement process, then we can start finding solutions.”

“This project explores solutions to organ transportation and will help optimize travel and troubleshoot for weather, traffic and flight changes in real time.”

Interested in increased efficiency?

UNOS technology specialists develop APIs that connect OPOs, transplant hospitals and histocompatibility centers so their applications can seamlessly exchange data with UNetSM applications. Learn about available APIs.

The post “An Expedia for organ transplantation” appeared first on UNOS.

Public comment open from Jan. 22 through March 24 2020

The Organ Procurement and Transplantation Network is offering 11 proposals for public comment beginning on Wed., Jan. 22.

Comments and replies will be published on https://optn.transplant.hrsa.gov/governance/public-comment/, to promote transparency and trust in the national transplant system. Visitors can also share comments on social media, if they wish.

We encourage patients, transplant candidates and recipients, living donors, donor families and transplant professionals to learn more about the proposals and provide valuable feedback to help shape U.S. organ transplant policy.

These are the proposals available for public comment:

  • HLA equivalency tables update 2020
  • Distribution of kidneys and pancreata from Alaska
  • Addressing medically urgent candidates in new kidney allocation policy
  • Enhancements to the National Liver Review Board
  • Data collection to assess socioeconomic status and access to transplant
  • Modify blood type determination and reporting policies
  • Guidance on blood type determination
  • Modifications to released kidney and pancreas allocation
  • National Heart Review Board for pediatrics
  • Update to VCA transplant outcomes data collection
  • Measuring transplant outcomes by collecting data on children born to uterus recipients

There are educational webinars available that provide everyone an opportunity to learn more about the proposals.

See webinar dates and register.

Public comment closes on March 24. All comments received about a proposed change are reviewed before the OPTN Board of Directors votes.

The post appeared first on UNOS.