What Referring Physicians Need to Know Explain the new kidney allocation policy and its goals Summarize basic changes in allocation components for deceased donor kidneys Describe patient indicators appropriate for transplant evaluation referral ID: 730760
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Slide1
The OPTN presents:
The New Kidney Allocation System:
What Referring Physicians Need to KnowSlide2
Explain
the new kidney allocation policy and its goals Summarize basic changes in allocation components for deceased donor kidneysDescribe patient indicators appropriate for transplant evaluation referralList resources for additional information including education of patients
ObjectivesSlide3
Richard Formica, Jr., MD
Associate Professor of Medicine & SurgeryYale University School of MedicineSlide4
Current Limitations
High kidney discard rates Variability in access to transplantUnrealized graft yearsUnnecessarily high re-transplant ratesWhy change kidney allocation?Slide5
Approximately
8,000 additional life years gained annually Improved access for:highly sensitized candidatesethnic minority
candidates
Comparable levels of kidney transplants at regional/national levels
Predicted outcomes of the changeSlide6
Major allocation components
Replace SCD/ECD with KDPIIncorporate A2
/A
2
B to B
Add longevity matching
Base pediatric priority on KDPI
Increase priority for sensitized candidates/CPRA sliding scale
Remove payback system
Include pre-registration dialysis time
Remove variancesSlide7
Implementation
Phase IPhase IIData updates required
New
reports released
Calculators made available
New
allocation rules applied
Variances turned off
Payback system turned off
Anticipated
mid
2014
Anticipated
end
2014Slide8
Importance of early referralSlide9
Revised waiting time calculation
CurrentNew
Reminder
Waiting time begins at/after registration with GFR <=20 ml/min
OR
On Dialysis
Waiting time points awarded for dialysis prior to registration (pediatric and adults)
Recognizes time spent with ESRD as basis for priority
Waiting time points based on GFR remains the sameSlide10
Sequence
ASequence B
Sequence
C
Sequence
D
Highly Sensitized
0-ABDRmm
(top 20% EPTS)
Prior living
donor
Local pediatrics
Local top 20% EPTS
0-ABDRmm (all
)
Local (all)
Regional pediatrics
Regional (top 20%)
Regional (all)
National pediatrics
National (top 20%)
National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adultsHighly Sensitized0-ABDRmmPrior living donorLocal RegionalNationalHighly Sensitized0-ABDRmmLocal + Regional National
0-ABDR Mismatch PrioritySlide11
Sensitized candidates
CurrentNew
CPRA
>=80
% receive 4 additional points and zero points for moderately sensitized candidates
Points assigned based on a sliding scale starting at CPRA>=20%Slide12
Point changes: Sensitization
0
0
0
0.08
0.21
0.34
0.48
0.81
1.09
1.58
2.46
4.05
6.71
10.82
12.17
17.30
0
2
4
6
8
10
12
14
16
18
20
0
10
20
30
40
50
60
70
80
90
100
Points
CPRA
CPRA Sliding Scale (Allocation Points)
(CPRA<98%)
New
CurrentSlide13
Sequence
ASequence B
Sequence
C
Sequence
D
Highly Sensitized
0-ABDRmm
(top 20% EPTS)
Prior living
donor
Local pediatrics
Local top 20% EPTS
0-ABDRmm (all
)
Local (all)
Regional pediatrics
Regional (top 20%)
Regional (all)
National pediatrics
National (top 20%)
National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adultsHighly Sensitized0-ABDRmmPrior living donorLocal RegionalNationalHighly Sensitized0-ABDRmmLocal + Regional National
New categories for highly sensitized candidatesSlide14
Meelie DebRoy, MD
Associate Professor of Surgery
Rutgers Robert Wood Johnson Medical SchoolSlide15
There is no established system to ensure that medically appropriate candidates are referred for transplantation
Early referralSlide16
Patients with chronic kidney disease (
Stage 3 or higher) or ESRD should be referred for transplant evaluationGuidance on early referralSlide17
Pre-emptive transplant and timely, early referral is the goal
GFR range = 25-30Education about transplant must begin before ESRD to be most effectiveStage 3-4 CKDBegin discussing the importance of living donors
Initiate weight loss and smoking cessation counseling as necessary
Guidance on early referral Slide18
Kidney Allocation System Communication, Education, and ResourcesSlide19
Kidney Allocation Toolkit
FAQsSample messaging for discussing changes with patientsPatient brochureGuidance for early referral considerationsSubscribe to RSS feeds and a monthly newsletter http://transplantpro.org/kidney-allocation-system/
Resources for professionalsSlide20
OPTN web site -
http://optn.transplant.hrsa.govUNOS web site* - http://www.unos.orgTransplant Living* - http://www.transplantliving.org
Transplant Pro* -
http://transplantpro.org
*These are a service of United Network for Organ Sharing
and are
not produced under the OPTN contract.
More information