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UNOS Update. Stuart Sweet, MD, PhD Immediate Past-President, UNOS Board of Directors Region 4 August 25, 2017. OPTN/UNOS Strategic Planning. Brainstorming themes. Better matching Faster placement, including analysis of historical offer acceptance
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UNOS Update Stuart Sweet, MD, PhD Immediate Past-President, UNOS Board of Directors Region 4 August 25, 2017
Brainstorming themes • Better matching • Faster placement, including analysis of historical offer acceptance • Automated decision-making aids (risk/benefit calculator, time to next offer) • Use of behavioral research to improve system interface • Focus on improvement • Peer coaching, effective practice sharing, COIIN • Re-examine outcomes thresholds, including development of long-term outcomes • More data, more easily • APIs, automated connections to EMRs • User-friendly DonorNet and other tools (DonorNet mobile, multi-platform, interface design) • Analysis tools – ROO, RUM, benchmark reports
Themes--Match More Equity Outcomes Safety Efficiency Match
Themes--Data More Equity Outcomes Safety Efficiency Data
Themes--Quality More Equity Outcomes Safety Efficiency Quality
New plan structure • Combined OPTN and UNOS plans • Shared high-level goals • Description of current activities • Opportunities for growth • Metrics
Plan Development Calendar 2017 • June: Board brainstorming session • July-Oct: Refining/seeking input November: ExCom/CAC review input/develop rough draft December: Board weighs in on rough draft ExCom and CAC finalize for PC
Plan Development Calendar 2018 • Jan-March: Draft plan out for public comment • April: ExCom/CAC meet in-person, finalize plan June: Board approves final plan July: New plan is effective
Cohort A Organ Acceptance Rate (50-100% KDPI) Kick-off and data collection Waitlist Management Organ Offer & Acceptance
COIIN Benefits from Cohort A Teams • “Bringing team together around common goals” • “Collaboration with other centers” and “Hearing the issues discussed with other centers” • “The review of offer acceptance criteria brought a lot of opportunities to our attention” • “Increased awareness by entire team” • “COIIN helped our collaboration with the OPO” • “Transparent data across all participants and contact information for collaboration across centers”
Liver Committee Work Plan Purpose: Revise exception eligibility criteria. Board Approved: Dec 2016 Purpose: Optimize the distribution system to reduce geographic variation in access to transplant Public Comment (2): July 31,2017 Purpose: Apply exception criteria uniformly. Board Approved: Jun 2017
Enhancing Liver Distribution Proposing 11-region sharing with 150 mile proximity circle including out of region patients: • 5 additional MELD/PELD points to patients within proximity circle • Sequence: Local Status 1A,Peds 1B, Region plus proximity circle • Share to:Adults: lab MELD > 29Pediatrics: allocation MELD/PELD > 29 • DCD and donors > age 70 excluded from this sharing algorithm
Fall Public Comment • Rationale for moving forward in parallel with additional modeling: • Direction and magnitude of impact on key metrics were consistent across older and newer cohorts. • Proposed solution will share to fewer proximity circle candidates than previous modeling (suggesting the prior modeling is a ceiling) • Sharing using MELD/PELD 29 threshold • Sharing based on lab MELD for adult candidates • Some additional modeling data will become available during public comment period
Fall Public Comment • SRTR Modeling (preliminary results 8/11): • Results similar to prior analyses: • Significant Decrease in Median MELD variance at txp • No change in transport time, increases in % organs flown and transport distance smaller than prior proposals • No change in total transplants or post-transplant mortality. Waiting list mortality rate and totals decrease • Final Report will include impact on vulnerable populations • Will be posted on website and feedback sought (including webinar)
Other OPTN/UNOS Activities • Ongoing Liver Committee Work: • Finalize disparity / impact metrics • Set targets for improvement • Additional policy modifications to meet disparity targets • System Optimization Proposal • Reduce time to access and respond to offers (60 to 30 min) • Limit decision time for primary offers to 60 minutes • Limit number of simultaneous acceptances to two donors • OPO / DSA Performance Metrics
Volunteers are Valuable!! • 41,762 Volunteer hours • Average number of hours 1-2 hours per week • Connection to the Transplant community • Meaningful and impactful work Thank you!
UNOS Update Stuart Sweet, MD, PhD Immediate Past-President, UNOS Board of Directors Region 4 August 25, 2017