Redefining Provisional Yes and the Approach to Organ Offer and Acceptance

At a glance

Current policy

Current OPTN policy defines provisional yes as when the transplant hospital notifies the OPTN or the host OPO that they have evaluated the offer and are interested in accepting the organ or receiving more information about the organ. Provisional yes is a tool used to manage organ offers; however, in the current system, it is not always effectively used. Because of a high number of offers received by transplant programs, provisional yes is potentially used without an evaluation of every offer. This concept paper discusses a potential solution that includes a three-tiered framework, and associated responsibilities, to standardize organ offer, review, and acceptance practices. Rather than a single provisional yes response with no associated responsibilities, each tier would represent the various stages of communication and responsibilities necessary between OPOs and transplant programs within the organ offer process.

Supporting media

Presentation

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Proposed concept

• Develop a tiered framework that will standardize organ offer, review and acceptance practices, and outline member responsibilities
• Recommend time limit on offers and number of offers that can be sent within tiers
• Increase efficiency and expedite organ placement
• Gather community feedback on framework

Anticipated impact

• What it's expected to do
  • Redefine “provisional yes”
  • Limit the amount of organ offers sent out to manage offer burden
  • Determine the appropriate time limits for organ offers
  • Reduce overall organ allocation time
  • Gather community feedback

• What it won't do
• This concept paper is intended to provide an update and solicit feedback; it will not result in a change in policy without additional public comment

Terms to know

• Provisional yes: When the transplant hospital notifies the OPTN or the host OPO that they have evaluated the offer and are interested in accepting the organ or receiving more information about the organ.
• Organ offer acceptance: When the transplant hospital notifies the host OPO that it accepts the organ offer for an intended recipient, pending review of organ anatomy. For kidney, acceptance is also pending final crossmatch.
• Organ offer refusal: When the transplant hospital notifies the OPTN or the host OPO that they are declining the organ offer.
• Organ procurement organization (OPO): An organization authorized by the Centers for Medicare and Medicaid Services, under Section 1138(b) of the Social Security Act, to procure organs for transplantation.
• Primary potential transplant recipient: The first candidate according to match run sequence for whom an organ has been accepted.
• Backup Offer: An organ offer made to a lower ranked candidate on a deceased donor match run after a transplant hospital accepts an organ on behalf of a higher ranked candidate, but before the organ is transplanted.
• Transplant program: A component within a transplant hospital that provides transplantation of a particular type of organ.

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