Read the full proposal (PDF – 153 K; 1/2018)

The OPTN/UNOS Operations and Safety Committee (the Committee) has updated the Guidance for ABO Subtyping Organ Donors for Blood Groups A and AB, originally developed by the Committee and approved by the OPTN/UNOS Board of Directors in June 2011.

Since the original publication, the Committee sponsored major revisions to ABO policies that were approved by the OPTN/UNOS Board of Directors and implemented in June 2016. During that process, the Committee identified the need to revise the subtyping guidance, as many questions emerged related to subtyping. Questions and identified issues include lab result nomenclature, results interpretation, and incomplete knowledge of policy requirements.

In addition, the revised Kidney Allocation System (KAS) went into effect in December 2014. It eliminated variances (including subtyping variances). KAS put use of subtyped deceased donors into policy to help promote greater access to kidneys for blood type B candidates. Allocation of kidneys using subtyped donors has increased. Pre-KAS there were 19 transplants (0.2% of all kidney transplants) using subtyped donors for blood type B candidates. Post-KAS (year 2) that number had risen to 168 (1.4% of all kidney transplants).

The revised guidance document is also part of efforts to assist members with subtyping. Nearly a quarter of OPOs had a subtyping issue cited on their last site survey. Instructional Innovations developed a subtyping e-learning module in response to these concerns. The guidance document is cited as a resource. It needs to be updated to complement the efforts aimed at improving compliant subtyping practices and reporting.

Changes made to the guidance document include:

• Updated OPTN Policy references
• Amended information about special considerations such as neonates
• Updated additional complementary resources
• Revised structure and addition of key points
• Modified language to read more as a plain language document

Specific questions

• The Committee changed the section that covers special considerations in subtyping including neonates and history of red blood cell transfusion. The Committee seeks feedback whether this guidance is sufficient or if more detail or policy is desired.
• The Committee also wants to know if there are related concerns not addressed in the guidance.