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Clarify Multi-Organ Allocation Policy

eye iconAt a glance

Current policy

Current policy addresses multi-organ combinations for heart, lung, and liver candidates on the waiting list that require a second organ. It does not address which match run is used for the second required organ or specifically define the second organ. This results in inconsistent application of the policy.

Supporting media

Presentation

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Proposed changes

  • Identify criteria for when Organ Procurement Organizations (OPOs) are required to offer the liver or kidney to a heart or lung candidate, if available, from the same donor.
  • Address heart-liver, lung-liver, heart-kidney, and lung-kidney multi-organ combinations.
  • Establish requirements for when OPOs must offer the liver or kidney when allocating according to the heart or lung match run.

Anticipated impact

  • What it's expected to do
    • Provide OPOs clearer direction when offering multi-organ combinations by establishing medical criteria for when OPOs must offer the liver or kidney to heart or lung candidates
      • Heart Adult Status 1, 2, and 3, Pediatric Status 1A and 1B
      • Lung Candidates with a lung allocation score of greater than 35
    • Increase “required offer” distance from the donor hospital to align with thoracic allocation
      • Heart – increase from 250 nautical miles (NM) to 500 NM to better align with current heart allocation
      • Lung – increase from 250 NM to 500 NM to be consistent within the proposed policy
    • Address 84% of combinations not currently addressed in other policies (heart-liver, lung-liver, heart-kidney, and lung-kidney combinations)
  • What it won't do
    • Does not address medical eligibility criteria or a “safety net” as used in current simultaneous liver-kidney policy
    • Does not establish requirements for which organs must be allocated first

Themes

  • Multi-organ policies
  • Heart and lung match runs

Terms to know

  • Organ Procurement Organization: An organization designated by the Centers for Medicare and Medicaid Services (CMS) and responsible for the procurement of organs for transplantation and the promotion of organ donation.
  • Match run: A computerized ranking of transplant candidates based upon donor and candidate medical compatibility and criteria defined in OPTN policies.
  • Safety Net: A concept that would increase priority on the deceased donor kidney waitlist for previous liver alone recipients that later develop end stage renal disease.
  • Click here to search the OPTN glossary

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