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Enhancing Kidney Transplant Outcomes: Proposal for Higher-Risk Kidneys Review

Addressing obstacles in post-transplant outcome review to reduce discarding of viable higher-risk donor kidneys, aiming to improve survival rates and quality of life for recipients. Proposal involves criteria adjustments and feedback mechanisms for member implementation.

thomasajohnson
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Enhancing Kidney Transplant Outcomes: Proposal for Higher-Risk Kidneys Review

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  1. MPSC Transplant Program Performance Measures (Outcome Measures) Membership and Professional Standards Committee

  2. What problem will the proposal solve? • MPSC post-transplant outcome-review process potentially creates disincentives to transplant higher-risk kidneys • Hundreds of potentially transplantable higher-risk donor kidneys discarded • Higher-risk donor kidneys may provide better survival rate and quality of life to candidates than staying on waiting list

  3. What is the proposed solution? • No kidney program would be reviewed by MPSC based solely on the outcomes in higher-risk kidney transplants • MPSC inquiry only if: • Program meets criteria for review for all kidney transplants AND • Program meets criteria for review with higher-risk kidney transplants removed • Higher Risk Transplants = recipient with EPTS score > 80 using a kidney from a donor with KDPI ≥ 85

  4. What is the proposed solution?

  5. Spring 2016 Discussions • Concept released for feedback in Spring 2016 • Regional Meetings • Kidney Transplantation Committee • June 2016 Board of Directors meeting • Questions posed • Is there support for specific exclusion of higher risk transplants? Donor characteristics, recipient characteristics or both? • Would a system like this encourage you to use currently discarded but transplantable kidneys? • Are there other issues that the MPSC work group should consider? • Feedback considered prior to release for public comment

  6. How will members implement this proposal? • No major changes to members’ role • Intended to encourage transplant programs to • Consider high KDPI kidneys for candidate with high EPTS scores • Review and make changes to candidate KDPI informed consent and offer acceptance practices and protocols

  7. How will the OPTN implement this proposal? • Board review December 2016 • MPSC will use this method to identify programs for outcomes review in the June 2017 MPSC Outcomes Reports • Monitoring of • National one-year graft- and patient-survival in higher-risk transplants • Changes in waiting list composition and acceptance and transplant behavior for higher-risk kidneys and higher risk candidates

  8. Questions? Jeffrey Orlowski, M.S., CPTC Committee Chair Jorlowski@lifeshareok.org Sharon Shepherd Performance Analysis and Improvement Subcommittee Liaison sharon.shepherd@unos.org

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