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Proposal to Modify Pediatric Lung Allocation Policy

Thoracic Organ Transplantation CommitteeFall 2015

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What problem will the proposal solve? May 2013: HHS requests that OPTN identify opportunities to improve

access for pediatric lung candidates June 2014: Board passes Adolescent Classification Exception Nov 2014: Board passes Pediatric Ethical Principles

Reviewed current lung policy with goal of increasing equity in access to size-matched organs for pediatric candidates and identified:

1.Alternative blood type matching permitted for hearts, not lungs

2.Broader geographic sharing through Zone B only of child (0-11) donor lungs to child candidates

1. Establish eligibility criteria for alternative blood type matching

How does the proposal address the problem?

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Eligibility criteriaClassified with

Age (at match) Medical urgency Titer<1 year old Priority 1 No limit Identical ABO*≥1 year old, registered before 2nd birthday

Priority 1 ≤1:16 Compatible ABO

*Priority 1 candidates <1 year old that are blood type compatible will be classified with identical blood types.

2. Broader sharing of all pediatric (<18) donor lungs

How does the proposal address the problem?

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*Continue to radiate in 500-mile concentric circles through Zone E

3. Prioritize children first (0-11), then adolescents (12-17), for all pediatric donor lungs (<18)

How does the proposal address the problem?

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Donor Age <18

Zone Candidate Age Group

Local + Zone A + Zone B 0-11Local + Zone A + Zone B 12-17Local ≥18Zone A ≥18Zone B ≥18Zone C 0-11Zone C 12-17Zone C* ≥18

*Zone C sequence continues through Zone E

Proposed changes supported by ethical principles

Alternative blood type matching may: Improve use of 0-2 year old donor lungs Improve waitlist mortality among infant candidates Benefit an estimated 12-14 candidates each year

Modeling for Broader Sharing showed: Increased transplant rates for 12-17 Trend toward increased rates for 6-11 No negative impact on other age groups

Supporting Evidence

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Supporting Evidence

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Consider listing patients meeting criteria as eligible to accept a blood type alternative organ Report titers upon indicating that a candidate is eligible and every 30 days after If available, report titers at transplant and if graft loss or death w/n one year

post-transplant

How will members implement this proposal?

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How does this proposal support the OPTN Strategic Plan?

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Supports: By:Broader sharing with child priority

Goal 2: Improve access Providing better access for all pediatric candidates to size-matched lungs

Alternative blood type matching

Goal 1: Increase transplants Increasing use of smallest donor lungs

Goal 3: Improve waiting list outcomes

Decreasing waitlist mortality among infants

Joe Rogers, MDCommittee Chair joseph.rogers@duke.edu

Regional representative name (RA will complete) Region X Representative email address

Liz Robbins CallahanCommittee Liaison liz.robbins@unos.org

Questions?

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