OPTN

OPTN Kidney Paired Donation Pilot Program

Ruthanne L Hanto RN, MPH

Program Manager, OPTN KPDPP

Regions 4 Meeting

May 11, 2012

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Discussion Data Guidelines and Proposed Policy

OPTN KPDPP Process Integration with UNetSM

How to join Webinar information Questions

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DATA

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Transplant centers who had preformed at least 1 KPD transplant in the U.S.

Segev, D KPD Consensus Conference April 2012 Dulles

+ HI

OPTN

2 4 6 19 34 2774

111

228

278

429 430

0

50

100

150

200

250

300

350

400

450

500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Number of KPD Transplants in U.S. by Year

http://optn.transplant.hrsa.gov/latestData/rptData.asp Living Donor Transplants By Donor Relation Based on OPTN data as of March 30, 2012

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Transplant centers participating in the OPTN KPDPP

118* Transplant centers 11 Regions

*As of May 9, 2012

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Candidate and Donor CharacteristicsMay 3, 2012 Match Run

Characteristic Candidates Donors

Total 150 167 (5 NDD)

Blood Type O 67.3% (101) 32.3% (54)

CPRA ≥ 80% 56.7% (85)

Willing to travel to matched center 7.3% (11) 32.3% (55)

Willing to ship/accept a shipped kidney from/to any center

92.7% (139) 97.0% (162)

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Total transplants and pending transplants to date

0

5

10

15

20

25

Oct 2010 - Aug 2011 Sept 2011 -May 2012

Transplants Pending

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GUIDELINES/

PROPOSED POLICY

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Why is the OPTN a Pilot Program?

To work out the logistics of KPD prior to setting policy

Currently participating transplant centers abide by Guidelines

Guidelines converted to public policy – proposal out Spring 2012

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Starting your KPD Program

Identify key personnel

Put processes in place

Get the word out to your patients

Identify potential KPD pairs

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OPTN Bylaws Requirements

Approved living donor kidney program

Notify OPTN Contractor in writing

Provide primary and secondary KPD contact

OPTN KPDPP Agreement

to Participate

OPTN KPDPP Agreement

to Participate

OPTN

Requirements for Participation

Candidate• On waiting list

Donors • 18yo or older• Listed in KPD only once

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OPTN KPDPP Required Consents

Agreement to Participate Form (separate)

Donor Education Documentation Forms

Candidate Education Documentation Forms

Authorization for Disclosure of Medical Information – HIPPA (no template – yet)

Accepting/shipping a living donor kidney

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Data Requirements

Donor & Candidate meet requirements for donation and transplantation

RequiredR data fields & Eligible* data fields Tissue typing requirements ABO verification A2 and A2B matching Donor and Candidate choices

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Required Policies

When/how matched donors and candidates can meet (communicate)

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PROCESS

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Match Run Announcement

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Match Run Announcement

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Match run schedule posted

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Match Run

Twice/month

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Types of KPD

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Donor Chains

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Prioritization PointsPriority Points Per Candidate

Base match per candidate (based on 200 points for a 2-way match) 100 points

Zero antigen mismatch with the matched donor 200 points

Highly sensitized candidate (CPRA ≥80%) 125 points

Prior living donor status of the candidate 150 points

Pediatric candidate (age <18 years) 100 points

Waiting time accumulated within the KPD program 2 points per match run

Geographic proximity with the matched donor (i.e. transplant center, local, regional)

75,50,25 points, respectively

Candidate’s other antibody specificities present in donor -5 points

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Edge Weights

Donor: BRecipient: A

Donor: ARecipient: B

Donor: ORecipient: A

XM+

Donor: ARecipient: O

Pair 1

Pair 3 Pair 4

Pair 2

525 325

675

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Match offers

Final acceptance

deadline

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Finances

• KPD Financial Recommendations

• KPD Financial Checklist

• KPD Financial Memo

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KPD Logistics

2 & 3 way exchange same day

Chains sequential

Candidate receives kidney before donor donates

Donor nephrectomy schedules within 3 weeks of paired candidate’s transplant

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KPD Logistics Transporting Kidneys

Chain of custody for shipping kidneys

UNOS works with center, OPO, courier in setting up transportation

OPTN

“Every system is perfectly designed to get the results it is getting”

- Don Berwick

OPTN

Process Improvement

Increase the number of match runs Decrease matches declined due to HLA

issues Allow Bridge Donors in the system Decrease matches declined due to

inactive pairs

OPTN

Process Improvement Increase the number of match run • 1x – 2x/month

Decrease matches declined due to HLA issues• HAC• Donor pre-select

Allow Bridge Donors in the system• Proposal out for public comment for bridge donors

Decrease number of decline due to inactive pairs• Education• Eligibility in UNetSM

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Automated SolutionReleased in Phases

Data entry Eligibility reports Donor pre-select Display of match offers Tracking of matches,acceptance,refusal View matched donor information Logistics sheet Contact information Match communication blog

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Unique to OPTN KPDPP

Transparency & Oversight

Priority Points – consistency in matching

Fully automated computer system integrated with UNET™

No additional OPTN or UNOS fees

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HOW TO PARTICIPATE IN THE OPTN KIDNEY PAIRED DONATION PILOT PROGRAM (KPDPP)

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Entering Pairs in OPTN KPDPP

Center signs agreement

Center activated in UNet™

Site administrator grants staff access

Enter pairs

OPTN KPDPP Agreeme

nt to Participate

OPTN KPDPP Agreeme

nt to Participate

OPTN

Demystifying the OPTN Kidney Paired Donation Pilot Program

KPD Basics Recording Available

Guidelines to KPD Finances: Who Pays for What Recording available

Unacceptable antigens in KPD

June 20th 2:00 – 3:00 PM ET

Navigating the Logistics of KPD

July 25th 2:00 – 3:00 PM ET

A B DR DP DQ

OPTN

Everything you want to know about the OPTN KPDPP

http://communication.unos.org/2012/02/everything-you-wanted-to-knowaboutthe-optn-kidney-