The allocation of donor hearts evolves in response to the changing landscape of advanced heart failure therapies and expanded understanding of donor/recipient matching. The novel, heart allocation algorithm is a natural response to the success of mechanical circulatory support (MCS) and further aligns severity of illness with urgency. In the novel, 6-status system, candidates supported with veno-arterial, extracorporeal membrane oxygenation devices (ECMO) and biventricular, extracorporeal ventricular assist devices (VAD) receive Status 1 urgency, while Status 2 urgency comprises candidates with univentricular extracorporeal VADs, percutaneous, endovascular mechanical circulatory support (e.g.
Donor heart selection and outcomes: An analysis of over 2,000 cases
Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere.
New booklet advises parents of pediatric transplant patients
A new resource booklet, “What Every Parent Needs to Know,” is available for parents and caregivers of children and adolescents who need or receive an organ transplant. The OPTN/UNOS Patient Affairs Committee spearheaded the booklet’s development in collaboration with a number of transplant professionals and parents of organ transplant recipients*.
The booklet explains the transplant process from a parent’s viewpoint. It addresses issues before and during a transplant such as financial concerns and explaining deceased donation to a child, as well as guidance on helping children manage life after a transplant. It addresses a number of concepts and terms relating to transplantation and provides references to other helpful resources.
* The Patient Affairs Committee also wishes to thank the following organizations for reviewing the booklet:
- American Liver Foundation
- American Society of Transplantation
- Anne & Robert H. Lurie Children’s Hospital of Chicago
- Children’s Cardiomyopathy Foundation
- Children’s Organ Transplant Association
- International Pediatric Transplant Association
- National Kidney Foundation
- Pediatric Heart Transplant Study
OPTN/UNOS Board members named
Richmond, Va. — Members of the national organ donation and transplantation community have elected 25 members to the OPTN/UNOS board of directors, including a new president, vice-president/president-elect, vice president for patient and donor affairs and secretary. United Network for Organ Sharing (UNOS) serves as the Organ Procurement and Transplantation Network (OPTN) under federal contract.
All board members are volunteers and serve terms ranging from one to three years, depending on the office to which they are elected. Their terms of service begin on July 1, 2018.
Sue Dunn, RN, B.S.N., M.B.A., currently the Vice President/President-Elect, will assume the presidency. She is president and chief executive officer of Donor Alliance in Denver.
Maryl Johnson, M.D., will become the Vice President/President-Elect. She is professor of medicine, heart failure and heart transplantation at the University of Wisconsin Hospitals and Clinics.
Deanna Santana, B.S., will become the Vice President for Patient and Donor Affairs. She is senior public education coordinator at Sierra Donor Services in Sacramento, Calif. She is also a donor mother and a living donor.
Theresa Daly, M.S., RN, B.S.N., FNP, will become the Secretary. She is director of transplant clinical operations at New York Presbyterian/Columbia Medical Center.
Other newly elected members are as follows:
Immediate Past President – Yolanda Becker, M.D., University of Chicago Medicine
Region 3 Councillor – Christopher Anderson, M.D., University of Mississippi Medical Center
Region 4 Councillor – Steven Potter, M.D., FACS, East Texas Medical Center
Region 5 Councillor – Kunam Reddy, M.D., Mayo Clinic, Phoenix
Region 6 Councillor – Susan Orloff, M.D., FACS, AASLD, Oregon Health & Science University
Region 9 Councillor – Rob Kochik, Finger Lakes Donor Recovery Network
At Large Abdominal Surgery Representative –, Rene Romero, M.D., Children’s Healthcare of Atlanta
At Large Hepatology Representative – Simon Horslen, M.B., Ch.B., Seattle Children’s Hospital
At Large Nephrology Representatives:
Eileen Brewer, M.D., Texas Children’s Hospital
Jerry McCauley, M.D., M.P.H., FACP, Thomas Jefferson University Hospital
At Large Pulmonology Representative – Marc Schecter, M.D., Children’s Hospital Medical Center, Cincinnati
At Large Transplant Administrator Representative – Timothy Stevens, RN, B.S.N. CCTC, Sacred Heart Medical Center
OPO Representative – Diane Brockmeier, RN, B.S.N., M.H.A., Mid-America Transplant Services
Histocompatibility Representative – Walter Herczyk, MT, CHS, Gift of Life Michigan Histocompatibility Laboratory
Transplant Coordinator Representative – Mary Francois, RN, M.S., CCTC, NATCO
Medical/Scientific Organization Representatives:
Sharon Bartosh, M.D., University of Wisconsin Hospital and Clinics
Charles Miller, M.D., Cleveland Clinic Foundation
Patient and Donor Affairs Representatives:
Randee Bloom, Ph.D., M.B.A., RN
Rosemary Berkery, J.D.
Laura DePiero, RN, B.S.N.
Joseph Hillenburg
Public comment sought
The Organ Procurement and Transplantation Network (OPTN) offers policy proposals for public comment from January 22 through March 23, 2018.
Comments and replies will be published on the OPTN public comment page, to promote transparency and trust in the national transplant system. Visitors can also share comments on social media, if they wish.
Feedback for selected proposals will be sought via a response form. This is part of a trial to study potential enhancements to the public comment process. For the proposals using the response form, the comments related to the proposal will be displayed on the public comment page in the same manner as the blog-style responses to all other proposals.
One of the proposals is a draft of an updated OPTN/UNOS strategic plan. The plan, to be finalized by the OPTN/UNOS Board of Directors after public input, will serve as a roadmap to help prioritize the OPTN’s work through 2021 and provide metrics to assess progress toward key goals.
We encourage patients, transplant candidates and recipients, living donors, donor families and transplant professionals to learn more about the proposals below and provide valuable feedback to help shape U.S. organ transplant policy:
- Aligning VCA program membership requirements with other transplant programs
- Modifications to the distribution of deceased donor lungs
- Clarifying informed consent policies for transmissible disease risk
- Concept paper on expedited organ placement
- Reducing reporting burdens and clarify policies on extra vessels
- Guidance on optimizing VCA recovery from deceased donors
- Changes to waiting time criteria for kidney pancreas candidates
- Modifying the lung Transplant Recipient Form to improve post-transplant lung function data
- Revising OPTN Bylaws Appendix L
- White paper on manipulating waitlist priority
- Guidance for ABO subtyping of Blood Type A and AB organ donors
- Concept paper on improving the OPTN/UNOS committee structure
- Guidance on deceased donor requested information
- OPTN/UNOS strategic plan
- Review board guidance on heart candidates with exceptions for HCM and RCM
Deceased organ donors in United States exceeded 10,000 for first time in 2017
During 2017, the number of deceased organ donors in the United States topped 10,000 for the first time, according to preliminary data from United Network for Organ Sharing (UNOS), which serves as the national Organ Procurement and Transplantation Network (OPTN) under federal contract. For the year, organs were recovered from 10,281 donors, representing a 3.1 percent increase over 2016 and an increase of 27 percent since 2007.
A total of 34,768 organ transplants were performed in 2017 using organs from both deceased and living donors, according to preliminary data. This total is a 3.4 percent increase over 2016 and marks the fifth consecutive record-setting year for transplants in the United States. Record number of donor organs were recovered and transplants occurred for each of the four most common organs transplanted – kidney, liver, heart and lung.
“We are grateful that more lives are being saved, year after year, thanks to the boundless generosity of organ donors,” said Yolanda Becker, M.D., president of the OPTN/UNOS Board of Directors. “We remain committed to increasing the number of transplants still further to help the many thousands of people in need of a transplant to sustain them and vastly improve their quality of life.”
Approximately 82 percent (28,587) of the transplants performed in 2017 involved organs from deceased donors. Living donor transplants accounted for the remaining 18 percent (6,181). In the 30-year span from 1988 (the first full year national transplant data were collected) through 2017, a total of 721,742 transplants have been performed nationwide.
While the number of potential organ donors varies among different areas of the country due to differences in population size and medical characteristics, increases were noted in many areas. Of the 58 organ procurement organizations (OPOs) coordinating deceased organ donation nationwide, 35 (60 percent) experienced an increase in donors from 2016 to 2017, including at least one OPO in each of UNOS’ 11 regions.
“Donation and transplantation continues to increase across the country,” said Brian Shepard, Chief Executive Officer of UNOS. “We are working with donation and transplantation professionals nationwide to help identify additional transplant opportunities and enhance the efficiency of the organ acceptance process.”
Broadening of clinical criteria for potential donors accounts for some of the ongoing increase in deceased organ donation and transplantation. In 2017, as compared to 2016, a higher proportion of donors had medical characteristics such as donation after circulatory death as opposed to brain death, drug intoxication as a mechanism of death, age of 50 or older, and/or being identified as having increased risk for blood-borne disease.
“As we increase our understanding of medical criteria that contribute to successful transplantation, donation and transplantation professionals have been able to use organs from a wider set of potential donors,” said David Klassen, M.D., UNOS Chief Medical Officer. “In doing so, we continue to carefully balance the opportunity for transplantation with a commitment to maintaining patient safety.”
United Network for Organ Sharing (UNOS) serves as the national Organ Procurement and Transplantation Network (OPTN) under contract with the Department of Health and Human Services, Health Resources and Services Administration. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.
Board of Directors releases University Hospitals of Cleveland from probation
At a meeting by teleconference October 3, 2017, the OPTN/UNOS Board of Directors restored full member privileges for University Hospitals of Cleveland, a transplant center in Cleveland, Ohio.
The Board had placed the hospital on probation in June 2016, after peer review of low transplant volume and early-term recipient deaths at its heart transplant program revealed concerns with the program’s quality management protocols. The hospital has since instituted actions that successfully address the previous concerns.
United Network for Organ Sharing (UNOS) serves as the national Organ Procurement and Transplantation Network (OPTN) under contract with the Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.