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Eliminate the Use of Donation Service Areas (DSAs) in Thoracic Distribution

Eliminate the Use of Donation Service Areas (DSAs) in Thoracic Distribution. Thoracic Organ Transplantation Committee Spring 2019. What p roblem will the proposal solve?. Ensure compliance with the Final Rule by removing DSA from heart allocation policy. What are the proposed solutions?.

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Eliminate the Use of Donation Service Areas (DSAs) in Thoracic Distribution

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  1. Eliminate the Use of Donation Service Areas (DSAs) in Thoracic Distribution Thoracic Organ Transplantation Committee Spring 2019

  2. What problem will the proposal solve? • Ensure compliance with the Final Rule by removing DSA from heart allocation policy

  3. What are the proposed solutions? • Replace DSA with a 250 NM distance from donor hospital • Remove policy language that permits prioritization of a sensitized heart candidate • Remove the term “zone” from OPTN policy and replace it with actual distances

  4. Supporting Evidence per the Final Rule • Based in sound medical judgement • Data driven: modeling, literature, expert and stakeholder input • Seeks to achieve the best use of donated organs and promote patient access to transplantation • Measured by waitlist mortality and transplant counts • Promote the efficient management of organ placement • Measured by travel time and costs

  5. How will members implement this proposal? • Transplant Hospitals • Surgical teams may be required to travel farther distances to recover organs • OPOs • OPOs may allocate organs to candidates who are farther away from the donor hospital

  6. How will the OPTN implement this proposal? • Committee will make recommendations to Board at June 2019 meeting • UNet Programming Changes: • Update adult and pediatric heart match allocations to replace DSA with 250 nautical mile distance • Update lung allocation policy to remove references to “zone” in classification titles

  7. Is the Committee seeking feedback • Would members recommend an alternative distance for thoracic distribution, versus the proposed distance of 250 NM? If so, what distance do you recommend and what evidence justifies this distance?

  8. Questions?

  9. Extra Slides

  10. Supporting Evidence • The Committee determined that replacing DSA with a 500 nautical mile allocation unit would not result in more consistency with the Final Rule • The Committee cited potential decreased system efficiency, decreased utilization, and poorer post-transplant outcomes resulting from the following: • Longer median travel times • Increased reliance on air travel • Higher likelihood of ischemic times exceeding four hours

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