An important message from the MPSC on best practices for ABO verification and other recommendations
Published on: Tuesday, January 14, 2025
For the benefit of the donation and transplant community, the OPTN Board has authorized the OPTN Membership and Professional Standards Committee (MPSC) to disseminate learnings and effective practices observed during MPSC meetings and interactions with OPTN members. Updates will be provided by the MPSC after each of their in-person meetings.
The MPSC recently communicated to a large segment of OPTN members about several recommendations and opportunities for improvement in processes and protocols related to organ recovery and transplant:
- Best practices for ABO verification
- Follow up on eGFR reviews
- Allocation out of sequence and hard-to-place organs
- Recommendations regarding living donor and paired exchange related events
These are areas of focus where the MPSC believes they can provide valuable information and tools to OPTN members for support and oversight.
The MPSC is an operating committee of the OPTN Board of Directors. In addition to monitoring for compliance with the OPTN Final Rule, policies, and bylaws, the committee supports members through peer review and sharing of effective practices. Find the MPSC’s community updates and other materials on the MPSC resources page.
Best practices for ABO verification
The MPSC continues to see challenges within the community in assessing and adjudicating discrepant blood typing results, especially in instances where the donor receives transfusions that could impact the accuracy of blood typing results. Currently, OPTN Policy 2.6 Deceased Donor Blood Type Determination and Reporting requires OPOs to “include a process to address conflicting or indeterminate primary blood type results in their written protocol” (2.6.A) and “document that reporting was completed according to the OPO’s protocol and the above requirements” (2.6.C).
It is imperative that OPTN members maintain thorough protocols that account for current standards in typing technology and highlight clear communication regarding the impact of mass transfusions. Documentation and communication of transfusion status was a focus of a previous MPSC Chair communication from Dr. Zoe Stewart-Lewis in October of 2023. The OPTN Operations and Safety Committee also has published “Guidance on Blood Type Determination” that is a helpful resource and reminder on best practices.
Follow up on eGFR reviews
The MPSC has concluded their eGFR compliance review related to OPTN Policy 3.7.D that began in January 2024 following the conclusion of the mandated attestation period. The committee would like to recognize and commend the community for all of the time and effort that was spent on this important project that aligns with the OPTN’s priority to provide equity in access to transplantation.
The OPTN is continuing to monitor the impacts of these policy changes. The 2-Year Race Neutral eGFR Calculations Monitoring Report was recently published and can be found here. The MPSC would also like to remind the community that all new potential recipients who identify as Black or African-American should be evaluated for qualifying eGFR values pursuant to OPTN Policy 3.7.D. It is also recommended as a potential best practice to share a reminder during annual visits about the potential for waiting time modification for kidney candidates affected by race-inclusive eGFR calculations in case they remember an encounter that might have had a qualifying eGFR result.
Allocation out of sequence and hard-to-place organs
The MPSC continues to see high rates of allocation out of sequence (AOOS) as part of allocation compliance reviews and understands that they are in large part due to efforts to utilize hard-to-place organs. While optimizing organ use and efficiency are key priorities of the OPTN, they need to be balanced by considerations of equity in access, and the community still has a responsibility to follow the organ offer and allocation system as laid out in OPTN Policy. The MPSC will continue to uphold those standards by reviewing instances of non-compliance and taking appropriate action.
Recommendations regarding living donor and paired exchange related events
Living donation, and by extension kidney paired donation, is subject to thorough requirements in OPTN Policy and is held to rigorous patient safety standards. The MPSC takes cases related to living donation very seriously and would like to emphasize the importance of reviewing and validating ALL internal and external sources of donor and recipient information including:
- Diagnostic testing (CT, X-ray, etc.)
- Source documentation (ABO, infectious disease, etc.)
We want to avoid situations where internal ABO source documents may not be compared with external documents, or diagnostic imaging results have not been thoroughly reviewed. All living donor and paired exchange programs should ensure that their processes include steps that confirm due diligence in preparations and review.
For questions or comments regarding this communication, please email MQFeedback@unos.org.