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Expedited Placement of Livers

This proposal aims to address the lack of policies regarding expedited liver placement, which has led to inconsistencies and lack of transparency. The proposed solutions include creating a system for expediting liver offers and implementing criteria for OPOs and transplant hospitals. Transplant hospitals must "opt-in" to receive expedited liver offers and must accept offers within 20 minutes. OPOs must meet specific conditions to initiate expedited liver offers. The OPTN will implement system programming changes to support this proposal.

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Expedited Placement of Livers

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  1. Expedited Placement of Livers OPO Committee

  2. What problem will the proposal solve? • Current OPTN policies do not address expedited placement • This absence of policies create: • Lack of transparency about how expedited placement currently works • OPOs and transplant hospitals have no formal guidance; perform inconsistently • Candidates have inconsistent access to organs

  3. What are the proposed solutions? • Create a system for expediting liver offers • Focus initially on expedited offers following “in-OR” turndowns • 70% of OPOs have at least one expedited placement reviewed by the MPSC each year • 60% of liver expedited placements reviewed were associated with intra-operative turndowns

  4. What are the proposed solutions? • Transplant hospitals must “opt-in” to receive expedited liver offers • OPOs will have criteria to initiate expedited liver offers • Transplant hospitals must accept offers within 20 minutes in order to be eligible to receive the liver

  5. “Opt-in” Criteria for Transplant Hospitals • Transplant hospitals must agree to allow any procurement team to recover the liver if necessary • Enter the following criteria for each type of donor (DCD and/or DBD) • Minimum and maximum age • Maximum body mass index (BMI) • Maximum distance from the donor hospital to transplant hospital • Minimum and maximum height • Percentage of macrosteatosis • Minimum and maximum weight

  6. Criteria for OPOs to initiate expedited liver offers OPOs can make expedited liver offers if they meet bothof these conditions: 1. The donor has entered the operating room or in the case of a DCD donor, withdrawal of life sustaining medical support has been initiated, whichever occurs first 2. The host OPO or Organ Center is notified by the primary transplant hospital that the primary potential transplant recipient will no longer accept the liver

  7. OPOs - Sending Expedited Liver Offers OPOs must enter the following information before sending electronic expedited liver offers: • Date and time donor entered the operating room (or life sustaining medical support was ) • Date and time transplant hospital notified the host OPO that they can no longer accept the liver offer. • Reason the primary potential transplant recipient refused the liver OPOs must make expedited liver offers using the expedited liver match run

  8. Responding to expedited liver offers • Transplant hospitals must accept expedited liver offers within 20 minutes to be eligible to receive the liver • At the end of the 20 minute timeframe, the liver will be placed with the candidate with an acceptance that appears highest on the match run

  9. Additional policy modifications • 5.4.C: Liver Offers – Added language to reference Policy 9.10.B: Expedited Liver Offers • 5.6.B: Time Limit for Review and Acceptance of Organ Offers – Added language to clarify that the acceptance time limit for expedited liver offers is 20 minutes instead of the 30/60 minutes in this policy

  10. How will members implement this proposal? OPOs • Explain the conditions appropriate for expedited liver placement • Educate their staff on required information related to sending expedited liver offers • Policy requirement to use expedited match run

  11. How will members implement this proposal? Transplant Hospitals • Must enter acceptance criteria on a candidate-by-candidate basis in order to receive expedited liver offers • Develop processes that allow quick review of expedited liver offers within the 20 minute time limit

  12. How will the OPTN implement this proposal? System programming changes include: • Adding new fields to Waitlist and DonorNet to allow transplant hospitals and OPOs to enter the required information • Creating a new match run type for expedited placement

  13. Work Group Roster

  14. Questions?

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