Definition of Transplant Policy Oversight Committee POC Fall

Definition of Transplant Policy Oversight Committee (POC) Fall 2014

The Problem § Questions from OPTN/UNOS members § § What is the definition of a transplant? Which date should be reported as the transplant date? § Current disconnect between policy definitions and clinical practices § Proposed definitions will help align policy requirements with current clinical practice

The Problem – Single Organ Transplants § Patient receives liver transplant, but organ is larger than expected. Surgical team does not immediately close the abdomen. Patient is removed from the OR and dies three days later. § Disconnect: According to current policy, the transplant was never completed

The Problem- Multi-organ Transplants § Recipient leaves OR after receiving first organ transplant and returns to OR next day for a second organ from same donor § Current policy: date of 2 nd organ transplant recorded as date of first organ’s anastomosis § § first transplant could have occurred more than 24 hours earlier Disconnect: program could need to remove a patient from waiting list before the second organ is transplanted

Goal of the Proposal § Maintain current reporting elements, while capturing existing clinical practice § Ensure data reported to the OPTN reflect what actually happens in a single-organ or multi-organ transplant

How the Proposal will Achieve its Goal Definition of Organ Transplant § An organ transplant BEGINS at anastomosis of the organ, and an organ transplant would be COMPLETE when: The cavity is closed and final stitch or staple applied or The recipient leaves the operating room, even if the chest or abdominal cavity cannot be closed

How the Proposal will Achieve its Goal Definition of Transplant Date: § Transplant date for an organ would be determined by the start of anastomosis for that organ, so you could have a multi-organ transplant occur on two different days § The beginning and completion of an islet infusion would not change

What Members will Need to Do § Accurately report data based on the proposed language § Apply the new definitions of organ transplant and transplant date when reporting in UNet. SM

Questions? § Yolanda Becker, MD Chair, Policy Oversight Committee ybecker@surgery. bsd. uchicago. edu § Leigh A. Kades, MA Liaison, Policy Oversight Committee leigh. kades@unos. org