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News

Data in Focus: Transplants continue under HOPE Act

UNOS researchers continue to track the impact of the HIV Organ Policy Equity Act (also known as the HOPE Act). Implemented in November 2015, the act allows research on transplantation of organs from donors identified as HIV-positive into HIV-positive candidates.

As of November 10, 2017, six IRB-approved transplant programs had performed 38 kidney and/or liver transplants under the HOPE Act, using organs from 16 deceased donors identified as HIV-positive. The chart lists the volume of transplants performed per month, omitting months where none were performed.

While initial transplant volume under the HOPE Act protocols has been lower than anticipated, such transplants provide additional opportunities for organ utilization and access to transplantation. They also may increase in the future as additional data becomes available on the safety and efficacy of transplantation from HIV-positive donors.

For more information, see the study UNOS researchers presented at the 2017 American Transplant Congress:
Wilk, Amber; Taranto, Sarah; Urban, Read; Klassen, David; “HOPE Act – The First Year,” American Transplant Congress, Chicago, 2017

 

Quarterly Update of Standardized Benchmark Reports Available

Transplant administrators, or anyone from your center with UNet access, may access standard benchmark reports. After logging on to UNet, select Resources from the main navigation bar and choose Data Services from the dropdown items. Then choose My Data Files in the left column.  Available later this month, the most recent quarterly update will include a snapshot of the waiting list at the end of September 30, 2017 and transplant data from August 1, 2016 to July 31, 2017.

When we first released the reports last November, we received feedback that the resource didn’t meet the needs of the pediatric community. In response, our latest update includes a pediatric supplement. Based on a transplant program’s number of pediatric candidates or recipients, some of you will notice supplemental pediatric chapters attached to your standard benchmark report. The pediatric report does not include new data. We simply restricted the data from the standard report by age at listing. Age is displayed with more granular pediatric categories. We also updated the labels and removed any adult-specific graphs or tables. Finally, unlike the size comparison group for the standard report, which is broken into four quartiles, the pediatric report consists of two groups, high and low volume.

Having current data delivered regularly will help you understand your patient population, listing practices, and transplant activity and compare it to others in your region and throughout the U.S. Over time, as policies and regulations change, we will update the contents of the report to make sure it provides the most useful information.

We provided this information to many of you previously but in the form of Excel documents, not visual charts that you can easily transfer to PowerPoint presentations or other shared reports. Using private funds, we are able to provide these reports to all transplant centers across the country at no charge.

For a small fee, however, we can create custom reports and have already done so for multiple centers. Depending on your needs, we can create a new comparison group, add your corporate branding colors, include your center’s metrics over a particular time period, add high quality images, and more. We’ll charge you an initial fee to build the custom report and then a maintenance subscription fee for each successive report.

Important: When we made the most recent quarterly update, we replaced the previous reports. However, if you need a particular archived report or want more information about a custom report, please email benchmark@unos.org or contact the research department through our existing data request process.

Access the latest educational resources

We will be adding the following educational recordings to UNOS’ Learning Management System, UNOS Connect, this month. To access them, follow these instructions:

  • After logging on to UNOS Connect, select Course Catalog from the main menu, then select the category icon appropriate for the recording.
  • Scroll down the list of titles to find what you are looking for.
  • Click register on the right hand side of the screen.

November – The Basics of Immunology

Category: Histo

Part one of the Histocompatibility learning series, this video provides basic knowledge of the human immune system and its components that play a role in organ transplantation.

November – Notification of Primary and Back Up Organ Offers

Category: UNet System

After collaborating with The Organization for Transplant Professionals (NATCO), we added new notifications to DonorNet® that will make it easier for OPOs and transplant hospitals to communicate the status of organ offers. A video showing you how to use the DonorNet tool will be available this month.

October – Updating the Patient Safety Contact List

Category: UNet System

Staff from OPOs and transplant centers staff now have the ability to update their Patient Safety Contacts and run reports in Secure Enterprise. This video will show them how to do it.

October – HCC Auto Approval Criteria Changes

Category – Liver

Get information on hepatocellular carcinoma (HCC) policy changes that align with the National Liver Review Board and enhancing liver distribution efforts. The new criteria will replace regional agreements that have been developed for HCC and create a national standard for candidate eligibility for exception points. It is scheduled to release in October.

October – TransNetSM VCA

Category: UNet System

This video walks staff through the steps to label and package VCA organs using the TransNet Application.

October – Adult Heart Allocation Policy Revisions

Category: Heart

The first in a series of instructional events related to adult heart allocation policy changes will explain the rationale behind these policy changes and describe the new medical urgency statuses. A recording of this live webinar, held  Oct. 26 at 3:00 p.m. ET, is now available.

September 19 – UNetSM Data Services Portal: “My Data Files” for Transplant Centers

Category – System

The second in a series about the UNet Data Services Portal, this live webinar held at 12:30 p.m. ET showcases how to construct reports available in the “My Data Files” section. Register in advance. If you miss the live event, we will post a recording that you can access at your convenience. 

September – Coordinator Retention

Category: Quality

We’ll add two podcasts  to the Transplant Coordinators Committee Learning Series this month. Transplant Coordinators Dawn Freiberger, from Children’s Hospital Boston, and Le Ann Stamos, from University of Utah Medical Center, will first outline the challenges of retaining OPO and Transplant Coordinators. The second audio recording continues the discussion with strategies to mitigate those factors.

August – VCA and OPOs

Category: VCA

Hear from several prominent figures in vascularized composite allograft (VCA) recovery and transplantation about how to begin a VCA recovery program at your OPO. You will also learn about VCA recovery in practical terms, and understand how VCA transplantation can benefit both your OPO and the eventual recipients.

July – Living Donor: The Typical Conversation

Category: Donor

Listen to examples of typical conversations with a living donor during the evaluation process. This video supplements DON100, which outlines current policy on informed consent.

July 12 – Data Services Portal: Kidney Waiting List Management Tool

Category: Liver

Register here for a live webinar where we demonstrate one of the many tools available in the Data Services Portal. Q&A will follow.

July 14 – OPO Allocation for Simultaneous Liver-Kidney (SLK)

Category: Liver

This video focuses on the changes in policy that OPOs will need to be aware of  so they can stay compliant in the allocation of livers and kidneys.

July 18 – Simultaneous Liver-Kidney (SLK) Allocation Town Hall

Category: Liver

Register here for a live town hall style webinar on July 18 that will begin at 2:00 p.m. EST. Members can ask questions about upcoming SLK policy changes and how they may be affected by them. If you miss the event, a recording will be available.

July 25 – Explaining Risk: Guidance on PHS Increased Risk Donor Organs

Category: Patient Safety

This video will enhance the transplant professionals’ knowledge of risks of disease transmission associated with transplantation of PHS increased risk donor organs.

June – Coordinating Organ Offers

Category: UNet System

This video summarizes the basics steps in organ allocation from match run, to organ offer, evaluation, and eventual response. It highlights effective practices, related to communication and evaluation.

June – TransNet Step-by-Step 

Category: UNet System

This step-by-step video provides instruction for each section of the main menu in the TransNet application. It is meant to supplement the training received at the OPO for new members or those who want a refresher of the application.

May – Simultaneous Liver-Kidney (SLK) Allocation Policy Changes

Category: Liver
Learn about the new medical eligibility criteria for adult candidates seeking an SLK transplant and how to be compliant with this policy change. Also learn about the new match classification priority (commonly called the “safety net”) for liver recipients who still need dialysis or have kidney dysfunction in their first year after liver transplant.

May – Waitlist Functionality for new Simultaneous Liver Kidney (SLK) Allocation Policy

Category: UNet System
This video includes the information from the SLK policy video but also instructs UNet users on how the UNet system will change. After watching, you will understand the new data collection requirements and the Waitlist functionality associated with SLK allocation.

May – Technological Advances and Ethical Conundrums: The Heart of the Matter – (final installment of 10-part series)

Category: Ethics
In the last instructional event of this series, we explore VCAs, elective transplants, inclusion/exclusion criteria, and immunosuppression and the effects these advances have on ethics in transplantation.

May – Infectious Disease Verification in the Living Donor 

Category: Patient Safety
Learn how developing a standard operating procedure for verifying infectious disease test results before living donor recovery can help you prevent disease transmission errors.

April – OPTN/UNOS KPD Message Board Page

Category: UNet System
This video teaches UNOS KPD program participants how to use the KPD message board page to improve communication among transplant hospitals during individual KPD exchanges. The improved communication decreases the average time from match offer to transplant, which increases the likelihood an exchange will progress to transplant.

April – Socio-Economic Ethical Matters: The Heart of the Matter – (ninth of a 10-part series)
Category: Ethics
Learn how socio-economic issues affect transplantation and ethics. Hear experts talk about how race, gender, and other social groupings affect access to transplant through justice and equity.

April Managing the Inactive Wait List (bonus installment of TCC Learning Series)
Category: Quality/Effective Practices
Clinical transplant coordinator at Yale New Haven Hospital, Sharon Klarman, shares with the transplant community how she uses data reports and a waitlist clinic to guide patients toward reactivation or removal from the waiting list following prolonged periods of inactivity. Before watching this video you must first watch, Managing the Waitlist: TCC Learning Series (SYS113).

April Resource Library
Access by clicking Resources from the left menu bar
Conveniently bundled together, this collection of materials and videos give you a high-level summary of UNOS and its services. It also includes modules describing the history of transplantation, how policies are made, and how to stay connected and informed. Be sure to scroll to the end to watch recordings of a donor family and recipient’s transplant story, as well as talks from OPO and transplant hospital staff on how such a match occurs. If you need to verify that you reviewed the content for orientation purposes, you may download a PDF that will add this course to your UNOS transcript.

March – Cultural Competency
Category: Quality
Dr. Juan Carlos Caicedo created a culturally competent donation program that resulted in a 74% increase in living kidney donations from the Hispanic population. In this 26 minute video, he addresses the general strategies he employed and how you can apply them to other organs and the particular demographics of any area.

MarchTransNet Case Movement
Category: UNet System
An interactive e-learning module provides a hands on opportunity for OPOs to confirm and/or increase their knowledge about case movement within the TransNet application.

MarchPediatric Lung Allocation
New Category: Pediatrics
Upcoming policy changes allow pediatric lung candidates listed before they are two years old to be considered for intended blood group incompatible matching. A decision tree PDF defines pediatric candidates meeting eligibility criteria for blood group intended incompatible lung and heart/lung transplants.

MarchEthics of Selection and Acceptance Criteria: The Heart of the Matter— (eight of 10-part ethics series)
Category: Ethics
Learn how selection and acceptance criteria are determined within the context of a sound ethical framework.Subject matter experts discuss ethical considerations regarding a candidate’s struggle with treatment compliance, addiction, obesity or if they are of advanced age and how the ethics behind these difficult decisions impact practice

MarchOPTN/UNOS KPD Message Board Page
Category: UNet System
After viewing this video, UNOS KPD program participants will be able to use the KPD message board page to better communicate with transplant hospitals for individual KPD exchanges. This improved communication will decrease the average time from match offer to transplant, thereby increasing the likelihood an exchange will progress to transplant.

February – Ethics of Increased Risk: The Heart of the Matter (sixth in a 10-part ethics series)
Category: Ethics
Explore increased risk donation. What are the challenges medical personnel face when donors have HIV, Hepatitis, cancer or other illnesses and how much should candidates be told about donor history? Also, how does increased risk to the recipient shape the ethics around transplant and how does high risk history play into donation and listing practices.

February Managing the Wait List (second installment of TCC Learning Series)
Category: UNet Systems
Clinical transplant coordinator at Yale New Haven Hospital, Sharon Klarman, shares with the transplant community how she manages waitlists using a systematic approach that leverages existing resources.

February  –Ethical Allocation: The Heart of the Matter (seventh of 10-part ethics series)
Category: Ethics
Subject matter experts discuss how allocation decisions strive to strike a balance between individual needs and common good. While considering age, status, obesity, geography and other considerations, allocation must also consider equity, fairness, beneficence and non-maleficence.

February  – Extra Vessels Handling and Storage Requirements
Category: Patient Safety
Learn the OPTN requirements of the storage and use of extra vessels, instances in which patient safety can be at risk, and practices to help avoid such instances.

New data submission compliance report

Implementation date: November 6, 2017

Audience

All transplant center staff who use UNetSM

Please pass this message along to anyone who may need to know this information.

At-a-glance

A new data submission compliance tool is available on the Data Services Portal in UNet. To access the report, log on to UNet, then follow this path: Resources>Data Services>My Data Files>Data Submission Compliance Report (file name: XXXX_YY1_DATASUB.XLSX).

Details

This multi-tabbed Excel report contains data regarding your transplant center’s compliance with OPTN policy 18.1 and CMS submission requirements.

  • The “Rates” tab provides overall completion rates by month the form was expected and by form type, for each organ type.
  • The “All Forms” tab contains details regarding each form’s submission status (one row per organ and form type); this allows you to easily identify which forms were submitted late.

If you are unable to access My Data Files from the Data Services Portal, you need to contact your UNet site administrator to adjust your permissions.

Contact

If you have questions, please contact UNOS Customer Service at 1-800-978-4334 or unethelpdesk@unos.org. If you have questions specific to the report (or others on the Data Services portal) itself, please contact dataportalfeedback@unos.org. For general questions, particularly those related to compliance, monitoring or policy, please contact your UNOS Regional Administrator at 804-782-4800.

Submitting LAS exception requests for candidates diagnosed with PH

 Audience: Physicians, surgeons, coordinators, UNetSM Site Administrators, program directors, and data coordinators at lung and heart/lung transplant programs.

Guideline: Lung transplant candidates diagnosed with pulmonary hypertension (PH) and who meet the following criteria may qualify for an increase in their Lung Allocation Score (LAS):

  1. Patient is deteriorating on optimal therapy, and
  2. Patient has a right atrial pressure greater than 15 mm Hg or a cardiac index less than 1.8 L/min/m2.

To request an increase in your PH candidate’s LAS,you must submit an exception request to the Lung Review Board (LRB); this request should include sufficient clinical detail to support that the patient meets the above criteria.

If you believe that your patient has similar waiting list mortality and potential transplant benefit as a PH patient meeting the above criteria, then you should provide a detailed narrative on that assertion and reference literature that supports your request for a higher LAS. Always provide a clinical justification for the exception.

Policy Reference

Refer to Policy 10.2.B (Lung Candidates with Exceptional Cases) for additional information about the exception review process.

The policy allows a transplant program to submit an exception request for an LAS, an estimated value for one of the tests that is used to calculate the LAS, or assignment to a diagnosis group for a disease that is not listed in WaitlistSM.

Note: The LRB will render clinical judgment on exception requests for higher LAS, diagnosis, or estimated value.

Transplant programs may wish to submit to the LRB an exception request for the candidate’s LAS to be at the national 90th percentile. See table below.

The LAS for all active candidates greater than or equal to 12 years of age waiting for lung transplants as of October 20, 2017 are as follows:

Questions?

Contact the UNetSM Help Desk at 1-800-978-4334 or unethelpdesk@unos.org. You may also contact your review board staff member: Regions 1 to 11 – Aaron McKoy at (804) 782-6575

Reporting key personnel changes

For continuity of care and the safety of transplant patients and living donors, it’s vital that all transplant programs and histocompatibility labs have key personnel that meet the training and experience criteria outlined in the OPTN Bylaws. That said, not all members are familiar with the process of reporting changes to key personnel. It can be particularly challenging if a key staff member departure is unexpected or happens very short-term.
You may find the flowchart below a useful reference for the process.

In addition, here are key things to remember:

  • Report any key personnel departure within seven days of learning of the departure (whether planned or unplanned). This allows UNOS staff to provide you the required applications as soon as possible, and it may help prevent your needing to inactivate because of vacant key personnel positions.
  • If you have someone else already on staff you propose as a replacement, be familiar with the key staff requirements. Requirements are outlined in the OPTN Bylaws, with a specific appendix for histo labs (Appendix C) and for each transplant program type (Appendices E through J).
  • If you don’t have an immediate replacement, you may need to inactivate the transplant program(s) affected (except for VCA programs). The inactivation requirements and actions are listed in Appendix K of the OPTN Bylaws.
  • The OPTN/UNOS Membership and Professional Standards Committee (MPSC) routinely reviews all instances of key personnel changes. By understanding the requirements and following the processes outlined, your program would not need to undergo additional MPSC review and potential action for non-compliance.

UNOS staff are happy to help answer questions or clarify information you need to complete the process. Call UNOS at 804-782-4800 and ask for a membership analyst to assist you.