Impact of Kidney Allocation System on Transplant Centers: Challenges, Changes, and Successes

1. Region 5’s Transplant Center Experience The Impact of the Kidney Allocation System Marlene Abe, Transplant Coordinator UCI Medical Center – Orange, California Jim Trisch, Manager – Clinical Services St. Vincent Medical Center- Los Angeles, California

2. Transplant Center Poll 11 73% 8 6 83% 5 Total Reponses: 76% *Please Note: Poll Did Not include Pediatric Centers

3. Transplant Center Poll 3 Survey Questions What 2 challenges have you encountered since the implementation of KAS? What 2 changes you have made as a result of the new KAS? What 2 successes have you encountered since the implementation of KAS? Additional Comments?

4. Question #1What challenges have you encountered since the implementation of KAS? • Responses: • (53%) Prior “Top listed” pts. were ready to go for tx. New top list “CPRA group”, some of these pts. are not ready to go. • Not mentally prepared - anticipated waiting longer • Pts. have not been recently seen by the team, do not have current sera, not financially cleared or insurance has changed • Pt. understanding of the new KAS - more pt. education needed, confusing and difficult for pts. to understand.

5. Question #1What challenges have you encountered since the implementation of KAS? • Responses: • (47%) Long distance OPOs refusing to send blood to facilitate cross match on high PRA pts. • Unable to do cross match prior to OR, demanding the tx ctr. does a virtual cross match first, which delays the process and increases the CIT. Possible manipulation of the system? • (12%) Kidneys from local donors use to stay locally, now most of those kidneys go outside the DSA to other centers.

6. Question #1What challenges have you encountered since the implementation of KAS? • Responses: • (1%) Increase volume of “ Top Listed” patients on waitlist • (1%) 98-100% Highly Sensitized patients coming up quicker than anticipated. • (1%) Scoring of pediatric en-bloc is not appropriate • Falling in the KDPI >85% requiring consent • (1%) Kidney’s are coming in for high PRA with no local back-up (back up not allowed for highly sensitized patients), therefore kidneys are being sent back

7. Question #2What changes you have made as a results of the new KAS? • Responses: • (100%) Implementation of a new KDPI Consent • (24%) Created an additional top listed pt. list to ensure these pts. are ready for tx (blood group & CPRA) • (24%) Education – staff, physicians, and patients • (5%) Increased age limit for organ acceptance which increased organ offers • (1 %) Review new “ Top Listed” to be financially cleared. • (1%) Look at MFI for all patients with high CPRA’s

8. Question #3What successes you have encountered since the implementation of KAS? • Responses: • (53%) More kidney offers, highly sensitized patients that never received an offer before are now receiving multiple offers and are getting transplanted quicker. More Transplants !! • (18%)Younger pt’s are coming up on the match run, offered better kidneys, offered younger kidneys • (18%) No benefits or success at this time

9. Additional Comments • Overall tx volume decreased (not sure if it is because of the new KAS) • Pediatric & K/P pts. - not receiving as many offers (majority of good kidneys going to the highly sensitized pts.) = longer wait time • Concerns: non-compliant pts. loose their kidneys & become highly sensitized, now being given priority & transplanted before other compliant pts., pediatric or K/P pts. • Still learning – virtual cross match when offered highly sensitized pts • Hopeful that the KAS will bring more equitability • Happy to see that paybacks are a “thing of the past”

10. The Impact of the Kidney Allocation System OPO Report Out - Region 5’s Survey Results Sara Bowman, Intermountain Donor Services Aaron Cohen , OneLegacy

11. OPO Poll 3 Survey Questions What 2 challenges have you encountered since the implementation of KAS? What 2 changes you have made as a result of the new KAS? What 2 successes have you encountered since the implementation of KAS? Additional Comments?

12. Question #1What challenges have you encountered since the implementation of KAS? • Increase in import offers and imports • Learning the logistics and gray areas between the KAS, PAS and Liver allocation • Logistics of orchestrating prospective x-matches with high CPRA candidates • Increased HLA laboratory demands for typing

13. Question #2What changes you have made as a results of the new KAS? • Biopsy criteria now considers KDPI instead of ECD • No longer tracking paybacks • Tracking more data (learned from our Share 35 experience) • Crossmatch Process Changes • Local Back-up Procedures

14. Question #3What successes you have encountered since the implementation of KAS? • Intended Receipents are being transplanted • Increased oppurtunities for staff education and optimazating of process •  Increased number of high CPRA candidates being transplanted • Increased interaction with local and regional transplant programs • Increased awareness of local center acceptance practice • Increased attention to how we can optimize placing

15. Provide 2 challenges you have faced since the • implementation of KAS? • Provide 2 changes you have implemented since the • implementation of KAS? • Provide 2 success since the implementation of KAS? Discussion Questions: