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The OPTN presents: The New Kidney Allocation System: What Referring Physicians Need to Know

The OPTN presents: The New Kidney Allocation System: What Referring Physicians Need to Know. Objectives. Explain the new kidney allocation policy and its goals Summarize basic changes in allocation components for deceased donor kidneys

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The OPTN presents: The New Kidney Allocation System: What Referring Physicians Need to Know

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  1. The OPTN presents:The New Kidney Allocation System: What Referring Physicians Need to Know

  2. Objectives • Explain the new kidney allocation policy and its goals • Summarize basic changes in allocation components for deceased donor kidneys • Describe patient indicators appropriate for transplant evaluation referral • List resources for additional information including education of patients

  3. Richard Formica, Jr., MD Associate Professor of Medicine & Surgery Yale University School of Medicine

  4. Why change kidney allocation? • Current Limitations • High kidney discard rates • Variability in access to transplant • Unrealized graft years • Unnecessarily high re-transplant rates

  5. Predicted outcomes of the change • Approximately8,000additional life years gained annually • Improved access for: • highly sensitized candidates • ethnic minoritycandidates • Comparable levels of kidney transplants at regional/national levels

  6. Major allocation components

  7. Implementation

  8. Importance of early referral

  9. Revised waiting time calculation Current Waiting time begins at/after registration with GFR <=20 ml/min OROn Dialysis • Waiting time points awarded for dialysis prior to registration (pediatric and adults) • Recognizes time spent with ESRD as basis for priority New Reminder Waiting time points based on GFR remains the same

  10. 0-ABDR Mismatch Priority

  11. Sensitized candidates CPRA >=80% receive 4 additional points and zero points for moderately sensitized candidates Current New Points assigned based on a sliding scale starting at CPRA>=20%

  12. Point changes: Sensitization CPRA Sliding Scale (Allocation Points) (CPRA<98%) 20 17.30 18 New 16 14 12.17 12 10.82 10 Points Current 8 6.71 6 4.05 4 2.46 1.58 2 1.09 0.81 0.48 0.34 0 0 0.21 0.08 0 0 0 10 20 30 40 50 60 70 80 90 100 CPRA

  13. New categories for highly sensitized candidates

  14. Meelie DebRoy, MD Associate Professor of Surgery Rutgers Robert Wood Johnson Medical School

  15. Early referral • There is no established system to ensure that medically appropriate candidates are referred for transplantation

  16. Guidance on early referral • Patients with chronic kidney disease (Stage 3 or higher) or ESRD should be referred for transplant evaluation

  17. Guidance on early referral • Pre-emptive transplant and timely, early referral is the goal • GFR range = 25-30 • Education about transplant must begin before ESRD to be most effective • Stage 3-4 CKD • Begin discussing the importance of living donors • Initiate weight loss and smoking cessation counseling as necessary

  18. Kidney Allocation System Communication, Education, and Resources

  19. Resources for professionals • Kidney Allocation Toolkit • FAQs • Sample messaging for discussing changes with patients • Patient brochure • Guidance for early referral considerations Subscribe to RSS feeds and a monthly newsletter http://transplantpro.org/kidney-allocation-system/

  20. More information OPTN web site - http://optn.transplant.hrsa.gov UNOS web site* -http://www.unos.org Transplant Living* -http://www.transplantliving.org Transplant Pro* - http://transplantpro.org *These are a service of United Network for Organ Sharing and are not produced under the OPTN contract.

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