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Ethical Implications of Multi-Organ Transplants (MOT)

This resource addresses the lack of standardization in Multi-Organ Transplant (MOT) allocation systems, aiming to solve confusion and inequity issues. Develop a white paper with recommendations for OPTN/UNOS Board. Recommendations include data reporting, transparency, and minimizing harm to disadvantaged subgroups.

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Ethical Implications of Multi-Organ Transplants (MOT)

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  1. Ethical Implications of Multi-Organ Transplants (MOT) Ethics Committee

  2. What problem will this resource solve? • Current MOT allocation systems are not standardized across organ type • Generates confusion in the community • Lack of consistency has potential to create/perpetuate inequity • Equity in access to transplant is #2 OPTN strategic goal • At the same time… • Amount of MOT have increased over the past two decades • Excluding KP and heart/lung, has doubled in the past six years, from 625 in 2012 to 1,035 in 2017 • Need for guidance/clarity

  3. How was this resource developed? • Throughout 2018, the Committee identified potential ethical dilemmas for current MOT policies • Solicited feedback from all 21 OPTN committees • Received feedback from members of the following committees: • Pediatric, Patient Affairs, Pancreas, Ops & Safety, Minority Affairs, Thoracic

  4. What are the proposed solutions? • Develop a white paper with recommendations for the OPTN/UNOS Board to consider in addressing MOT allocation

  5. Ethical dilemmas addressed • Degree of need • Waitlists and the “pulling of organs” • Organ quality • Treatment options other than transplantation • Prioritization of MOT over SOT (single organ transplant) • Regionalization • Protected Subgroups • Monitoring MOT in transplant programs • Fairness to patients awaiting SOT • Standardized Criteria for MOT • Relative Futility • Impact of adult MOT on pediatric SOT

  6. Recommendations Include: • Establish data reporting for MOT outcomes • Improve transparency and create standards • Consider establishing minimum requirements for MOT • Medical urgency important qualifier • Consider additional “safety net” policies for other MOT combinations • Don’t disadvantage patients who undergo SOT instead of MOT • Minimize added harm to subgroups already disadvantaged in access to transplants • Children, minority populations, highly sensitized patients

  7. How will members implement this resource? • Does not require any member action • Will be available as a reference on the OPTN website pending approval by the Board of Directors

  8. How will the OPTN implement this resource? • Will be available through the OPTN website • If approved, could serve as reference for the Board of Directors and committees considering future policy changes to MOT

  9. Questions?

  10. Extra Slides

  11. Pediatric candidates • Focus of paper on adult candidates because the challenges with pediatric candidates may be substantively different for MOT • However, Committee solicited and received feedback from Pediatric Committee, which asked for more discussion on pediatrics • In response to Pediatric Committee, Ethics Committee added language to “Protected Subgroups” section discussing the impact on pediatric candidates

  12. MOT Increase • Excluding KP and heart/lung, MOT has doubled in the past six years, from 625 in 2012 to 1,035 in 2017 • The reason for this increase is not readily apparent • The Committee considered investigating the reason for this increase, but after discussion, agreed the most relevant and important takeaway for the ethical implications of MOT is the fact of the increase, not the reason for it

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