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Regional Review Board Guidance for Adult Congenital Heart Disease Exception Requests

Regional Review Board Guidance for Adult Congenital Heart Disease Exception Requests. Thoracic Organ Transplantation Committee. What problem will the proposal solve?. Concern that adult congenital heart disease (ACHD) candidates will be disadvantaged under the new policy:

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Regional Review Board Guidance for Adult Congenital Heart Disease Exception Requests

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  1. Regional Review Board Guidance for Adult Congenital Heart Disease Exception Requests Thoracic Organ Transplantation Committee

  2. What problem will the proposal solve? • Concern that adult congenital heart disease (ACHD) candidates will be disadvantaged under the new policy: • Higher urgency statuses are device-driven • Variability in review board decision-making for ACHD exception requests • Challenging to objectively quantify severity of illness

  3. What are the proposed solutions? • Suggests objective criteria to define a pathway to the higher urgency statuses for ACHD • Provides: • Guidelines about statuses appropriate for specific conditions • Rationale and context to justify the recommendations, potentially helping review boards without a CHD expert • Specific, objective criteria the RRBs can use to evaluate exception requests, potentially increasing standardization of decision-making • Should help RRBs recognize more medically urgent ACHD candidates requesting exceptions and can grant access to the higher urgency statuses.

  4. What are the proposed solutions? • Two broad categories: • Single ventricle ACHD candidates • Criteria suggests exception pathways for status 1, 2, 3 • Dual ventricle ACHD candidates • Criteria suggests exception pathway for status 3 • Candidate must be admitted to the transplant hospital that registered the candidate to the waiting list.

  5. How will members implement this proposal? • Heart programs should consider this guidance when submitting exception requests for their adult congenital heart disease candidates • Guidelines are voluntary and not prescriptive of clinical practice • No additional data collection required

  6. How will the OPTN implement this proposal? • Anticipated Board review date: Dec. 2017 • Guidance posted on OPTN website once adult heart allocation system policy changes are implemented • Members will not be evaluated for compliance based on guidance

  7. Questions? Kevin Chan, MD Committee Chair kevichan@med.umich.edu Kimberly Uccellini, MS, MPH Committee Liaison Kimberly.Uccellini@unos.org

  8. Backup slides

  9. Supporting Evidence

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