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Education available for DonorNet organ offer system changes

A new educational offering is available in UNOS Connect to explain upcoming phase 2 system and policy changes to improve organ placement offers in DonorNet. Phase 2 changes take effect June 13, 2018.

An eLearning module, Limit Organ Offer Acceptances by Organ Type, illustrates how OPOs will use the new system enhancements to  manage organ offer acceptances. It covers new requirements for limiting the number of organ offer acceptances per candidate, per organ type, and explains how OPOs must use the system to make the allocation process more efficient.

A document explains Phase 1 changes to DonorNet and policy that occurred on May 2, 2018.

Learn more about the project and view the schedule.

Questions

Please contact:

  • Education@unos.org for instructional questions.
  • Regional Administrators at (804) 782-4800 for policy questions.
  • UNetSM help desk at (800) 978-4334.

Interested in additional instructional offerings?

Please visit UNOS Connect for more offerings.

Frequently asked questions about DonorNet organ offer system changes

Updated 5/22/2018

An OPTN/UNOS Board-approved project to improve organ offer and acceptance process will result in changes to DonorNet® and policy in May and June 2018. The following questions and answers should help OPO and transplant center staff members prepare for the changes.

Learn more and access resources.

Phase 1: Reduce the current time limits for responding to organ offers from two hours to one hour 

How will this policy impact the amount of time transplant hospitals have to respond to organ offers?

Currently, transplant hospitals have one hour to access the donor information in the match system and an additional hour to refuse the offer or enter a provisional yes. The policy change will require transplant hospitals receiving initial offers to access the donor information and submit a provisional yes or an organ offer refusal within one hour.

What happens if the transplant hospitals do not respond within the timeframe?

The OPO can offer the organ to transplant hospitals for the next candidate on the match run.

How will the system notify transplant hospitals of initial organ offers?

Initial notifications will remain unchanged. If the organ offer is not acknowledged after 10 minutes, the system will send a second notification to the primary and secondary contact. If no response after an additional 10 minutes (20 minutes after initial notification), the system will notify the primary and secondary contact.

What happens when a transplant hospital is the primary offer or becomes the primary offer?

If a transplant hospital is primary for a candidate on the initial offer, they will have one hour from the time the OPO notifies them of primary status and all donor information required by Policy 2.11 has been provided to respond to the OPO with an organ offer acceptance or refusal.

If a transplant hospital was not the primary center on the initial offer and has previously entered a provisional yes for a candidate, then becomes the primary center, they will have 30 minutes from the time the OPO notifies them of primary status and all donor information required in Policy 2.11 has been provided to respond to the OPO with an organ offer acceptance or refusal.

Policy 5.6.B makes it permissible but does not require OPOs to move on to the next candidate on the list if a decision is not made within the timeframes outlined in the policy (60 minutes for initial primary center, 30 minutes if previous provisional yes has been entered and center becomes primary). Ongoing communication between OPOs and transplant hospitals is extremely important when placing organs. There will always be a need for OPOs and transplant hospitals to communicate while trying to get the right organs placed with the right candidates within a reasonable amount of time.

Will DonorNet still display the time left to respond?

Yes, the current “notification time remaining” and “evaluation time remaining” will change to “time to respond” on the organ offers page for active notifications and evaluation offers.

Notify as Primary/Backup Notification Tool

This optional DonorNet® feature enables OPOs to notify transplant hospitals who have entered a provisional yes that their candidate is either the primary or back-up on a match. The additional notification is meant to expedite the organ offer process by keeping transplant hospitals more informed regarding their candidate’s relative position on the match and allows the transplant hospital to be prepared when an OPO calls to notify them of primary.

This tool must not be used to start the clock on the timeframes referenced in Policy 5.6.B. These timeframes are dependent on the required deceased donor information in Policy 2.11 as well as additional information as agreed upon by the OPO and transplant hospital. The use of this tool is optional and OPOs must still initiate contact with the transplant hospital by phone. If OPOs use this tool, it is recommended that they wait 10-15 minutes to allow the transplant hospital to review the message before making a follow up phone call. 

Phase 2: Limit the number of organ offer acceptances to two

How will the system count organ offer acceptances?

Acceptances will only count toward the limit if the match is still open AND the OPO has not completed the organ disposition (donor feedback). If the match is just locked, the acceptance will continue to count. If the OPO closes the match or completes donor feedback, then the acceptance no longer counts toward the limit and will not display in the offer acceptance detail section.  Additionally, an acceptance will not count for a given candidate once a recipient has been removed from the Waitlist as transplanted for the same donor ID and same organ (and laterality).  Per Policy 3.9 (Removing Candidates from the Waiting List), candidates must be removed from the waiting list within 24 hours of transplant.

Acceptances entered before implementation will be included in the acceptance count.  This means that if a transplant center has accepted more than two offers for a candidate before implementation then the offer acceptance detail section will display all of these acceptances and the system will prevent additional acceptances from being entered until the acceptance count drops below the limit.    As OPOs close out matches and complete organ disposition (donor feedback) these acceptances will no longer count toward the limit and will not appear in the offer acceptance detail section.

How will a transplant hospital know when their candidate has reached the limit of organ offer acceptances?

Transplant hospitals will see a warning that their candidate has reached the maximum number of organ offers. Offer acceptance information will be displayed in the “offer details” section

How will an OPO know when a transplant candidate has reached the limit of organ offer acceptances?

OPOs will be notified when a candidate has reached the maximum number of offers. This information will be displayed in the “offer details” section in DonorNet. The system will not allow the OPO to enter a third acceptance for that candidate. There is a link to an organ offer acceptance report that will display additional information about all offer acceptances for the candidate. (Do we need to list these?)

Will a transplant candidate still receive organ offers if they have reached the limit?

Yes, all candidates will continue to receive organ offers and transplant hospitals can still enter provisional yes acceptances. A provisional yes does not count towards the limit.

What does a transplant hospital need to do in order to accept an additional offer?

The transplant hospital will need to contact one of the host OPOs (for the previously accepted offers) so the OPO can change the one of the previous acceptances to an organ offer refusal. 

What are an OPO’s options when a transplant center has reached the limit and they want to accept a third organ for the same candidate? 

An OPO cannot enter a third acceptance. The transplant center must contact one of the host OPOs to refuse one of the previously accepted offers.

What are the options for reaching an OPO in order to decline an offer?

The transplant program should use the OPO Contact Number at the top of the match or the OPO contact number in the acceptance details to contact the coordinator responsible for that donor. OPOs should keep this number updated even after all organs have been allocated. If the OPO does not respond, the transplant program should utilize the “Member Main Phone Contact” tool on the Waitlist, under “Resources”.  The UNOS Organ Center can assist in providing contact numbers but cannot enter a refusal on a match run for a case that has not been offered through the Organ Center.

What are the OPO requirements for managing organ offer acceptances?

Policy 5.6.B does not require OPOs to enter a final acceptance (“organ placed”) into the system until all information according to Policy 2.11 (Required Deceased Donor Information) is available to the transplant hospitals. While Policy 5.6.C states that the “host OPO must immediately report transplant hospital organ offer acceptances to the OPTN Contractor” there still needs to be ongoing communication between OPOs and transplant hospitals regarding the required information and any additional information, such as kidney laterality, needed to make that final decision. Once there is agreement on this information then the organ offer acceptance must be entered on the match run. This requirement is necessary in order for organ offer acceptance to be monitored in real time.

Schedule of upcoming heart, liver policy actions

UNOS will implement the new adult heart allocation policy, national liver review board (NLRB) and enhancements to liver distribution policy before the end of 2018. To allow for multiple policies to be made effective in a short timeframe, UNOS will implement these policies according to a closely coordinated schedule. In particular, certain elements common to the NLRB and liver distribution policy require the NLRB to be in place before liver distribution is finalized.

Throughout the rest of the calendar year, UNOS will be offering a series of educational events and resources to help you and your patients prepare for these changes. The following chart shows when upcoming educational opportunities are scheduled, as well when the various policies are to be implemented. Liver information is shaded in blue; heart is shaded in green.

Please note: While some specific dates have been established, others have not been finalized. We will continue to update this schedule as additional dates are set. We will also keep the dates of previous training opportunities and policy implementation as a reference.

Additional information

 

Additional data elements in Center STAR files available June 4

Transplant center STAR files contain datasets of information related to your waiting list registrations and transplants. UNOS creates the file based on data your center enters into Waiting List and TIEDI applications as well as additional data elements collected from OPOs and histocompatibility labs. We also include patient deaths reported from other sources.

Based on requests from transplant professionals and also items identified by UNOS research staff, we have added data elements to the center STAR files. The updated data files that reflect the specific changes will be available on June 4, 2018; updated corresponding file layouts will be made available, along with the current file layouts, on May 23, 2018. Consequently, you need to be sure to adjust any automated process you use to import these files.

We will implement the following changes with the June Center STAR file release:

Additions

  • LIVER: Donor INR; Recipient Crossmatch (T cell, B cell); SODIUM170_VAL_DON; HBA1C
  • KIDPAN: HBA1C

Deletions

  • KIDPAN: DAYSWAIT_CHRON_KI and DAYSWAIT_CHRON_PA – The values for these fields are also captured by the DAYSWAIT_CHRON field, therefore are duplicative and will be removed; DAYSWAIT_CHRON field will remain.

Where to find them
All centers can access their center STAR files from the Data Services Portal in UnetSM. Select Resources from the main menu, then Data Services, then My Data Files. You’ll find the updated file layouts under Documentation. If you are unable to access any of these sections, contact your UNet site administrator.

What you should know about Center STAR files

  • Data is available “on demand” to all centers with no need to submit a data request
  • We update the information monthly
  • Information includes all waiting list registrations and transplants performed at your institution since 10/1/1987
  • You can access detailed follow-up, post-transplant malignancy, and immunosuppression information about your transplant recipients
  • Available in both SAS CPORT and delimited formats

Questions?
Contact UNOS Customer Service at 1-800-978-4334 or dataportalfeedback@unos.org.

2018 UNOS TMF breaks records and earns high ratings

An all-time record number of attendees (587), sponsors and exhibitors gathered at the Renaissance Austin Hotel, April 24-26, for a Texas-sized 2018 UNOS Transplant Management Forum (TMF). The UNOS Transplant Administrators Committee (TAC) and UNOS staff appreciate everyone involved for contributing to the success of the 26th annual forum and learning opportunity for transplant professionals.

View photos from the event.

Presentations covered an array of topics in transplantation, including big data, xenotransplantation, upcoming changes to liver and heart allocation, and much more.

Attendees rated the sessions highly. Here’s what some of them had to say.

  • Great conference over all. Can honestly say I learned several things each day. Thank you to the planning committee ….
  • Really appreciated the center/speaker sharing the very comprehensive education program and resources that they developed for their patients and staff. Some very thoughtful ideas were shared.
  • Good meeting[;] Dynamic presentations

Gwen McNatt, Ph.D., RN, won the Heckenkemper Award for Excellence in Transplantation. She serves as Director of Kovler Organ Transplantation at Northwestern Memorial Hospital in Chicago, Illinois.

See the award presentation.

David Lewino, RN, CCTC and Melissa Niman, MA, MEd from University of California San Diego Health, La Jolla won the Best of the Best abstract award.

Get details about submitting an abstract for 2019.

The TAC and UNOS are already hard at work planning for 2019 TMF, to be held May 14-16 at the Universal Lowes Sapphire Falls Resort in Orlando, Florida. Exhibitors and sponsors who are interested 2019 opportunities, learn more or contact Meeting Partners at UNOS.

Coming Soon: 5-Tier Outcome Assessment Update

In approximately two weeks, a new version of the SRTR beta site will be available for review and comment. A beta version of the SRTR website containing the 5-tier outcome assessment has been available online over the past year. During that time, SRTR has worked with HRSA and the SRTR Visiting Committee (SVC) to consider feedback from transplant professionals, researchers, and patients and their family members. SRTR has been working with HRSA and the SVC to implement a series of changes in response to that feedback. Additionally, the Agency for Healthcare Research and Quality (AHRQ) funded research by Drs. Ajay Israni and Cory Schaffhausen that studies how patients use and interpret the information on the SRTR website. Their research led to a number of suggested improvements in the how the data is presented for public consumption.

With HRSA and the SVC’s guidance, SRTR developed an improved version of the beta website. The new version includes 5-tier assessments of waitlist mortality and deceased-donor transplant rate, in addition to posttransplant outcomes, indicators of which metrics have the most overall impact on patient survival following listing, and improved language and educational material. SRTR will launch the updated beta site for a 60-day comment and review period. This update to the beta site is expected to go live by mid-May.

Visit staff members from SRTR at the 2018 American Transplant Congress (ATC) meeting (June 2-6), booth #202, to ask questions. Review the current version of the beta site.