Modifications to Heart Allocation Policy

1
Modifications to Heart Allocation Policy

• Implemented July 12, 2006
• Changed the allocation order for medically urgent
  (Status 1A and 1B) patients
• Policy Change

• 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.

• 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.

2
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

3
Composition of Heart Waiting List by Medical
Urgency7/5/2006 9/19/2007
Based on OPTN data as of September 21, 2007
4
Number of Active Heart Candidates on the Waiting
List by Week and Region7/5/2006 9/19/2007
Based on OPTN data as of September 21, 2007
5
Heart Transplants by recipient age
group7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007
Based on OPTN data as of September 21, 2007
6
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007
Based on OPTN data as of September 21, 2007
7
Heart Transplants by Geographic
Location7/12/2005-7/11/2006 vs.
7/12/2006-7/11/2007
Based on OPTN data as of September 21, 2007
8
Heart Transplants by Geographic Location and
Medical Urgency Status7/12/2005-7/11/2006 vs.
7/12/2006-7/11/2007
Based on OPTN data as of September 21, 2007
9
Heart Transplants by Region7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007
Based on OPTN data as of September 21, 2007
10
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 1
Based on OPTN data as of September 21, 2007
11
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 2
Based on OPTN data as of September 21, 2007
12
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 3
Based on OPTN data as of September 21, 2007
13
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 4
Based on OPTN data as of September 21, 2007
14
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 5
Based on OPTN data as of September 21, 2007
15
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 6
Based on OPTN data as of September 21, 2007
16
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 7
Based on OPTN data as of September 21, 2007
17
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 8
Based on OPTN data as of September 21, 2007
18
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 9
Based on OPTN data as of September 21, 2007
19
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 10
Based on OPTN data as of September 21, 2007
20
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 11
Based on OPTN data as of September 21, 2007
21
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 1
Based on OPTN data as of September 21, 2007
22
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 2
124
120
79
57
58
36
48
44
18
10
NJTO
PADV
PATF
Based on OPTN data as of September 21, 2007
23
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 3
69
67
57
49
46
45
30
28
27
26
22
26
20
17
13
12
4
6
FLMP
FLUF
FLWC
GALL
LAOP
MSOP
PRLL
Based on OPTN data as of September 21, 2007
24
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 4
86
83
77
77
32
25
23
15
Based on OPTN data as of September 21, 2007
25
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 5
175
162
92
93
53
53
40
28
16
13
4
1
Based on OPTN data as of September 21, 2007
26
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 6
41
31
22
23
1
1
Based on OPTN data as of September 21, 2007
27
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 7
90
77
65
63
39
40
19
18
Based on OPTN data as of September 21, 2007
28
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 8
59
50
47
40
33
30
19
14
9
6
Based on OPTN data as of September 21, 2007
29
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 9
147
126
17
11
10
3
Based on OPTN data as of September 21, 2007
30
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 10
75
71
64
38
35
32
20
22
19
14
Based on OPTN data as of September 21, 2007
31
Heart Transplants by Status7/12/2005-7/11/2006
vs. 7/12/2006-7/11/2007Region 11
62
57
54

37
34
26
26
19
23
22
20
20

13
13
Based on OPTN data as of September 21, 2007
32
Preliminary Results for Death Per 100 Years on
the Waiting List All Statuses Combined11/12/2005
-7/11/2006 vs. 7/12/2006-3/11/2007
Deaths include those reported to the OPTN or to
SSDMF while on waiting list or non-transplant removal.
Based on OPTN data as of July 6, 2007
33
Preliminary Results for Death Per 100 Years on
the Waiting List All Ages Combined11/12/2005-7/1
1/2006 vs. 7/12/2006-3/11/2007
Deaths include those reported to the OPTN or to
SSDMF while on waiting list or non-transplant removal.
Based on OPTN data as of July 6, 2007
34
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.

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36
Modifications to Kidney Allocation Policy
Pediatric Priority for Donors

Implemented on September 28, 2005

Priority for allocation of kidneys from donors
less than 35 years to pediatric candidates listed
prior to age 18 locally, regionally, then
nationally.

37
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

38
Deceased Donor Kidney TransplantsBy Donor Age
and Recipient Age3/28/04 9/27/05 vs. 9/28/05
3/27/07
Age 11-17
39
Deceased Donor Kidney Transplants, 3/28/04
3/27/07By Time Period, Donor Age and Recipient
Age
Age 18
Age 6-10
Age 0-5
Age 11-17
40
Kidney Transplants, 3/28/04 3/27/07By Period,
Donor Type and Recipient Age
Age 18
Age 6-10
Age 0-5
Age 11-17
41
Waiting List Removals during 3/28/04 3/27/06By
Time Period and Age at Listing
Age 0-17
Age 18
42
Percent Transplanted Within 12 MonthsWL
Additions during 9/28/04 8/27/06By Policy
Period and Age at Listing
43
Kidney Transplants, 3/28/04 3/27/07By Period,
DR HLA MM Level and Recipient Age
Age 0-17
Age 18
44
Pediatric Kidney Waiting List Candidates at
Month End for Jan 2005 May 2007
45
Pediatric Additions during the Month and Active
Pediatric Candidates Waiting at Month End, Jan
2005 May 2007
46
Kaplan-Meier Graft Survival by Policy
PeriodPediatric Recipients of DD Kidney
Transplantsduring 9/28/04-9/27/06
P-value 0.21
47
Kaplan-Meier Patient Survival by Policy
PeriodPediatric Recipients of DD Kidney
Transplantsduring 9/28/04-9/27/06
P-value 0.76
48
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.

49
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.