Transcript UNOS Standard

Modifications to Heart Allocation
Policy
 Implemented
July 12, 2006
 Changed the allocation order for medically urgent
(Status 1A and 1B) patients
 Policy Change:

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
OPTN

Local Status 1A
Local Status 1B
Local Status 2
Zone A Status 1A
Zone A Status 1B
Zone A Status 2
Zone B Status 1A
Zone B Status 1B
Etc.



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

Local Status 1A
Local Status 1B
Zone A Status 1A
Zone A Status 1B
Local Status 2
Zone B Status 1A
Zone B Status 1B
Zone A Status 2
Etc.
Background
 Goals
of the Policy:
• Reduce waiting list mortality for urgent patients
by increasing priority of urgent Status 1A and
1B candidates
 This
presentation will review changes during
the first 12 months following the policy
implementation
OPTN
Composition of Heart Waiting List by
Medical Urgency
7/5/2006 – 9/19/2007
3,000
Number of candidates
2,500
2,000
1,500
1,000
500
Snapshot date
Status 1A
OPTN
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Status 7
9/19/2007
9/5/2007
8/1/2007
7/4/2007
6/6/2007
5/2/2007
4/4/2007
3/7/2007
2/7/2007
1/3/2007
12/6/2006
11/1/2006
10/4/2006
9/6/2006
8/2/2006
7/5/2006
0
Number of Active Heart Candidates on the
Waiting List by Week and Region
7/5/2006 – 9/19/2007
200
150
100
1
OPTN
2
3
4
5
6
Based on OPTN data as of September 21, 2007
7
8
9
10
11
9/5/2007
8/5/2007
7/5/2007
6/5/2007
5/5/2007
4/5/2007
3/5/2007
2/5/2007
1/5/2007
12/5/2006
11/5/2006
10/5/2006
9/5/2006
0
8/5/2006
50
7/5/2006
Number of candidates
250
Heart Transplants by recipient age group
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
1901
2,000
1884
Number of Transplants
1,800
1,600
1,400
1,200
1,000
800
600
400
197
214
200
126
107
0
0-10 Years
11-17 Years
7/12/05-7/11/06 (N=2224)
OPTN
Based on OPTN data as of September 21, 2007
18+ Years
7/12/06-7/11/07 (N=2205)
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Number of Transplants
1,200
1,000
1039
894
775
800
827
555
600
339
400
200
0
Status 1A
Status 1B
7/12/05-7/11/06 (N=2224)
OPTN
Based on OPTN data as of September 21, 2007
Status 2
7/12/06-7/11/07 (N=2205)
Heart Transplants by Geographic Location
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Number of Transplants
1,400
1,200
1323
1064
944
1,000
702
800
600
400
175 177
200
19 14
5
6
0
Local
Zone A
Zone B
7/12/05-7/11/06 (N=2224)
OPTN
Based on OPTN data as of September 21, 2007
Zone C
Zone D
7/12/06-7/11/07 (N=2205)
Heart Transplants by Geographic Location
and Medical Urgency Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
50
Percent of Transplants
45
40
4.4
4.1
2.8
35
30
3
15.5
24.3
12.9
10.4
25
1.8
5.7
20
15
10
20.6
18.5
21.8
21.4
1.8
5.7
17.4
5
7.9
0
Pre
Post
Status 1A
Local
OPTN
Pre
Post
Status 1B
Zone A
Based on OPTN data as of September 21, 2007
Pre
Post
Status 2
Other
Heart Transplants by Region
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Number of Transplants
400
350
300
250
200
150
100
50
0
1
2
3
4
5
6
7/12/05-7/11/06
OPTN
Based on OPTN data as of September 21, 2007
7
8
9
10
7/12/06-7/11/07
11
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 1
100
90
80
70
60
50
40
30
20
10
0
87
72
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 2
326
Number of Transplants
350
300
269
250
200
150
100
50
0
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 3
287
Number of Transplants
350
300
277
250
200
150
100
50
0
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 4
Number of Transplants
250
208
210
Pre
Post
200
150
100
50
0
Status 1A
OPTN
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 5
400
364
362
Pre
Post
Number of Transplants
350
300
250
200
150
100
50
0
Status 1A
OPTN
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 6
66
Number of Transplants
70
60
54
50
40
30
20
10
0
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 7
Number of Transplants
250
210
201
200
150
100
50
0
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 8
180
160
140
120
100
80
60
40
20
0
152
155
Pre
Post
Status 1A
OPTN
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 9
200
180
160
140
120
100
80
60
40
20
0
175
142
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 10
Number of Transplants
250
220
171
200
150
100
50
0
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 11
Number of Transplants
250
231
191
200
150
100
50
0
Pre
Status 1A
OPTN
Post
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 1
90
80
70
60
50
40
30
20
10
0
78
68
9
4
Pre
Post
Pre
CTOP
Status 1A
OPTN
Post
MAOB
Status 1B
Based on OPTN data as of September 21, 2007
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 2
Number of Transplants
140
120
124
120
100
79
57
80
36
60
40
20
44
48
Pre
Post
58
18
10
0
Pre
Post
DCTC
Pre
MDPC
Status 1A
OPTN
Post
NJTO
Status 1B
Based on OPTN data as of September 21, 2007
Pre
Post
PADV
Pre
Post
PATF
Status 2
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 3
80
70
57
60
67 69
49
45 46
50
40
30
27 26 30 28
26
20
22
17
20
4
6
13 12
10
Pr
e
Po
st
Pr
e
Po
st
Pr
e
Po
st
Pr
e
Po
st
Pr
e
Po
st
Pr
e
Po
st
Pr
e
Po
st
Pr
e
Po
st
Pr
e
Po
st
0
ALOB
AROR
FLMP
Status 1A
OPTN
FLUF
FLWC
GALL LAOP
Status 1B
Based on OPTN data as of September 21, 2007
MSOP
Status 2
PRLL
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 4
100
90
80
70
60
50
40
30
20
10
0
77
25
23
86
Pre
Post
32
15
Pre
Post
Pre
OKOP
Post
Pre
TXGC
Status 1A
OPTN
77
83
TXSA
Status 1B
Based on OPTN data as of September 21, 2007
Post
TXSB
Status 2
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 5
200
180
160
140
120
100
80
60
40
20
0
162
92
53
175
93
53
40
4
16
1
28
13
Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post
AZOB
CADN
Status 1A
OPTN
CAGS
CAOP
Status 1B
Based on OPTN data as of September 21, 2007
CASD
UTOP
Status 2
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 6
45
40
35
30
25
20
15
10
5
0
41
31
1
1
Pre
Post
HIOP
Status 1A
OPTN
22
23
Pre
Post
Pre
Post
ORUO
WALC
Status 1B
Status 2
Based on OPTN data as of September 21, 2007
Number of Transplants
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 7
100
90
80
70
60
50
40
30
20
10
0
90
77
65
40
Pre
Post
Pre
ILIP
Post
Pre
MNOP
Status 1A
OPTN
63
WISE
Status 1B
Based on OPTN data as of September 21, 2007
39
Post
19
18
Pre
Post
WIUW
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 8
Number of Transplants
70
59
60
50
47
50
40
40
33
30
30
19
20
10
6
9
Pre
Post
14
0
Pre
Post
CORS
IAOP
Status 1A
OPTN
Pre
Post
MOMA
Status 1B
Based on OPTN data as of September 21, 2007
Pre
Post
MWOB
Pre
Post
NEOR
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 9
147
Number of Transplants
160
126
140
120
100
80
60
17
40
20
10
11
3
0
Pre
Post
NYAP
Status 1A
OPTN
Pre
Post
Pre
Post
NYFL
NYRT
Status 1B
Status 2
Based on OPTN data as of September 21, 2007
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 10
Number of Transplants
80
71
75
64
70
60
50
40
32
38
35
22
30
20
19
20
14
10
0
Pre
Post
INOP
Pre
Post
MIOP
Status 1A
OPTN
Pre
Post
OHLB
Status 1B
Based on OPTN data as of September 21, 2007
Pre
OHLP
Post
Pre
Post
OHOV
Status 2
Heart Transplants by Status
7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Region 11
Number of Transplants
70
62
57
54
60
50
40
30
37
34
26
20
23
19
20
26
22
20
13 13
10
0
Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post
KYDA
NCCM
NCNC
Status 1A
OPTN
SCOP
TNDS
Status 1B
Based on OPTN data as of September 21, 2007
TNMS
VATB
Status 2
Deaths Per 100 Patient Years
Preliminary Results for Death Per 100 Years on
the Waiting List: All Statuses Combined
11/12/2005-7/11/2006 vs. 7/12/2006-3/11/2007
30
27.4
25
20.2
20
15
15.7
14.5
11.9
11
10
5
0
All Ages
11/12/05-7/11/06
0-17
18+
7/12/06-3/11/07
* Deaths include those reported to the OPTN or to SSDMF
while on waiting list or < 7 days of non-transplant removal.
OPTN
Based on OPTN data as of July 6, 2007
Deaths Per 100 Patient Years
Preliminary Results for Death Per 100 Years on
the Waiting List: All Ages Combined
11/12/2005-7/11/2006 vs. 7/12/2006-3/11/2007
120
100
96.3
80
60
40
30.3
20.3
20
11.8
5.8
0
Status 1A
Status 1B
11/12/05-7/11/06
Status 2
7/12/06-3/11/07
* Deaths include those reported to the OPTN or to SSDMF
while on waiting list or < 7 days of non-transplant removal.
OPTN
3.7
Based on OPTN data as of July 6, 2007
Summary



Small decline in size of total waiting list candidates
No change in the number of heart transplants comparing
pre- and post-policy periods
Substantial change in distribution of transplants by location
and status
• More Status 1A and Status 1B transplants and fewer Status 2
transplants
• Fewer local transplants and more Zone A transplants

Preliminary data suggest a decrease in waiting list mortality
rates

Thoracic Committee and Heart Allocation Task Force monitoring
impact of policy changes.
OPTN
OPTN
Modifications to Kidney Allocation
Policy – Pediatric Priority for
Donors < 35 years
 Implemented
 Priority
on September 28, 2005
for allocation of kidneys from donors less
than 35 years to pediatric candidates listed prior to
age 18 locally, regionally, then nationally.
OPTN
Background
 Goal
to get “good” kidneys to children quickly with
minimal impact on adult candidates
 This
presentation will review results of the first 18
months following policy implementation
OPTN
Deceased Donor Kidney Transplants
By Donor Age and Recipient Age
3/28/04 – 9/27/05 vs. 9/28/05 – 3/27/07
Donors 35 +
Number of Transplants
Donors 0-34
700
11
600
500
400
104
300
200
100
0
17
67
2
104
Pre
Post
Age 0-5
OPTN
17
80
5
128
288
Pre
Post
Pre
Age 6-10
601
Post
Age 11-17
Deceased Donor Kidney Transplants, 3/28/04 – 3/27/07
By Time Period, Donor Age and Recipient Age
Donors 35 +
Donors 0-34
2
100%
17
17
11
5
104
80%
7,827
8,701
5,653
5,378
3/28/04 9/27/05
9/28/05 3/27/07
60%
104
40%
67
80
601
128
288
20%
0%
3/28/04 9/27/05
9/28/05 3/27/07
Age 0-5
OPTN
3/28/04 9/27/05
9/28/05 3/27/07
Age 6-10
3/28/04 9/27/05
9/28/05 3/27/07
Age 11-17
Age 18+
Kidney Transplants, 3/28/04 – 3/27/07
By Period, Donor Type and Recipient Age
Living
Deceased
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
74
165
84
3/28/04 9/27/05
126
106
97
9/28/05 3/27/07
3/28/04 9/27/05
Age 0-5
OPTN
111
133
9/28/05 3/27/07
Age 6-10
263
365
612
392
3/28/04 9/27/05
9/28/05 3/27/07
Age 11-17
9,393
9,015
13,480 14,079
3/28/04 9/27/05
9/28/05 3/27/07
Age 18+
Waiting List Removals during 3/28/04 – 3/27/06
By Time Period and Age at Listing
Died
Deceased Donor Tx
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
125
130
315
238
34
39
8,259
Other
10,929
6,266
6,517
5,896
5,716
13,248
13,845
3/28/04 - 9/27/05
9/28/05 - 3/27/07
971
662
3/28/04 - 9/27/05
9/28/05 - 3/27/07
Age 0-17
OPTN
Living Donor Tx
Age 18+
Percent Transplanted Within 12 Months
WL Additions during 9/28/04 – 8/27/06
By Policy Period and Age at Listing
9/28/04-8/27/05
9/28/05 - 8/27/06
60
51.4
Percent
50
48.4
53.7
51.2
44.1
39.5
40
51.9
42.8
30
20
11.6 11.8
10
0
0-5
6-10
11-17
Age at Listing
OPTN
All Peds
Adults
Kidney Transplants, 3/28/04 – 3/27/07
By Period, DR HLA MM Level and Recipient Age
2 DR MM
1 DR MM
0 DR MM
100%
80%
200
396
4,156
4,719
5,731
5,947
3,588
3,401
3/28/04 - 9/27/05
9/28/05 - 3/27/07
60%
40%
281
384
20%
92
70
0%
3/28/04 - 9/27/05
9/28/05 - 3/27/07
Age 0-17
OPTN
Age 18+
0%
OPTN
May 07
Mar 07
Jan 07
Nov 06
337
329
442
427
318
326
407
428
318
317
427
424
320
322
426
451
309
324
414
422
334
323
428
406
317
286
489
446
286
281
475
506
274
495
272
500
Active
Sep 06
Jul 06
May 06
Mar 06
Jan 06
266
261
527
547
227
221
591
589
209
597
203
613
180
199
196
629
60%
184
190
610
80%
Nov 05
Sep 05
Jul 05
May 05
Mar 05
605
596
613
40%
Jan 05
Pediatric Kidney Waiting List Candidates
at Month End for Jan 2005 – May 2007
Inactive
100%
20%
Pediatric Additions during the Month and Active
Pediatric Candidates Waiting at Month End,
Jan 2005 – May 2007
Active Candidates on the List
Additions to the WL
700
600
500
400
300
200
100
OPTN
May 07
Mar 07
Jan 07
Nov 06
Sep 06
Jul 06
May 06
Mar 06
Jan 06
Nov 05
Sep 05
Jul 05
May 05
Mar 05
Jan 05
0
Kaplan-Meier Graft Survival by Policy Period
Pediatric Recipients of DD Kidney Transplants
during 9/28/04-9/27/06
9/28/04-9/27/05
9/28/05-9/27/06
100
95
Survival (%)
90
85
80
P-value = 0.21
75
70
65
60
0
OPTN
3
6
Months Post-Transplant
12
Kaplan-Meier Patient Survival by Policy Period
Pediatric Recipients of DD Kidney Transplants
during 9/28/04-9/27/06
9/28/04-9/27/05
9/28/05-9/27/06
100
95
Survival (%)
90
85
80
P-value = 0.76
75
70
65
60
0
OPTN
3
6
Months Post-Transplant
12
Summary

Preliminary results show that the number and
percentage of pediatric kidney transplants from
deceased donors less than age 35 has increased since
the policy change, and fewer pediatric candidates are
waiting for a transplant.

Deceased donor transplantation appears to be
occurring more rapidly among pediatric recipients.

The number of living donor pediatric kidney transplants
appears to have decreased, and this will be closely
monitored.
OPTN
Summary



The number and percent of less well HLA matched
transplants increased after the policy implementation.
Graft and patient survival for transplants performed
during the 12 months before the policy and 12 months
after the policy implementation were not significantly
different.
Pediatric and Kidney Committees monitoring impact of
the policy change.
OPTN