the impact of the new kidney allocation system on donation and transplantation in region 5

The Impact of the new Kidney

Allocation System on Donation and

Transplantation in Region 5

Session Overview

KAS Data HLASurvey ResultsBreakout Discussion

The Impact of the Kidney Allocation System

Marlene Abe, Transplant CoordinatorUCI Medical Center – Los Angeles

Jim Trisch, Manager – Clinical ServicesSt. Vincent Medical Center- Los Angeles

Region 5’s Transplant Center Experience

Transplant Center Poll

0

2

4

6

8

10

12

Marlene Jim

Centers Polled

Centers Responded

11

8

65

73%

83%

*Please Note: Poll Did Not include Pediatric Centers

Total Reponses: 76%

3 Survey Questions

Transplant Center Poll

What 2 challenges have you encountered since the implementation of KAS?

What 2 successes have you encountered since the implementation of KAS?

What 2 changes you have made as a result of the new KAS?

Additional Comments?

Question #1What challenges have you encountered since the

implementation of KAS?

• Responses:– (53%) Prior “Top listed” pts. were ready to

go for tx. New top list “CPRA group”, some of these pts. are not ready to go. •Not mentally prepared - anticipated waiting

longer•Pts. have not been recently seen by the team, do

not have current sera, not financially cleared or insurance has changed

•Pt. understanding of the new KAS - more pt. education needed, confusing and difficult for pts. to understand.



• Responses:– (47%) Long distance OPOs refusing to

send blood to facilitate cross match on high PRA pts. • Unable to do cross match prior to OR,

demanding the tx ctr. does a virtual cross match first, which delays the process and increases the CIT. Possible manipulation of the system?

– (12%) Kidneys from local donors use to stay locally, now most of those kidneys go outside the DSA to other centers.



• Responses:– (1%) Increase volume of “ Top Listed” patients

on waitlist – (1%) 98-100% Highly Sensitized patients

coming up quicker than anticipated. – (1%) Scoring of pediatric en-bloc is not

appropriate• Falling in the KDPI >85% requiring consent

– (1%) Kidney’s are coming in for high PRA with no local back-up (back up not allowed for highly sensitized patients), therefore kidneys are being sent back

Question #2What changes you have made as a results of the

new KAS?

• Responses:– (100%) Implementation of a new KDPI Consent – (24%) Created an additional top listed pt. list to

ensure these pts. are ready for tx (blood group & CPRA)

– (24%) Education – staff, physicians, and patients– (5%) Increased age limit for organ acceptance

which increased organ offers– (1 %) Review new “ Top Listed” to be financially

cleared.– (1%) Look at MFI for all patients with high

CPRA’s

Question #3What successes you have encountered since the


• Responses:– (53%) More kidney offers, highly

sensitized patients that never received an offer before are now receiving multiple offers and are getting transplanted quicker. More Transplants !!

– (18%)Younger pt’s are coming up on the match run, offered better kidneys, offered younger kidneys

– (18%) No benefits or success at this time

Additional Comments• Overall tx volume decreased (not sure if it is

because of the new KAS)• Pediatric & K/P pts. - not receiving as many offers

(majority of good kidneys going to the highly sensitized pts.) = longer wait time

• Concerns: non-compliant pts. loose their kidneys & become highly sensitized, now being given priority & transplanted before other compliant pts., pediatric or K/P pts.

• Still learning – virtual cross match when offered highly sensitized pts

• Hopeful that the KAS will bring more equitability • Happy to see that paybacks are a “thing of the

past”


OPO Report Out - Region 5’s Survey Results


Sara Bowen, Organ Recovery CoordinatorIntermountain Donor Services

Aaron Cohen, Manager of Donor Referral and Allocation

OneLegacy

Region 5’s OPO Experience

3 Survey Questions

OPO Poll

What 2 challenges have you encountered since the implementation of KAS?

What 2 successes have you encountered since the implementation of KAS?

What 2 changes you have made as a result of the new KAS?

Additional Comments?



• Increase in import offers and imports• Learning the logistics and gray areas

between the KAS, PAS and Liver allocation

• Logistics of orchestrating prospective x-matches with high CPRA candidates

• Increased HLA laboratory demands for typing

Question #2What changes you have made as a results of the

new KAS?

• Biopsy criteria now considers KDPI instead of ECD

• No longer tracking paybacks• Tracking more data (learned from

our Share 35 experience)• Crossmatch Process Changes• Local Back-up Procedures

Question #3What successes you have encountered since the


• Intended Receipents are being transplanted• Increased oppurtunities for staff education and

optimazating of process• Increased number of high CPRA candidates being

transplanted• Increased interaction with local and regional

transplant programs• Increased awareness of local center acceptance

practice• Increased attention to how we can optimize placing

Discussion Questions:

• Provide 2 challenges you have faced since the implementation of KAS?

• Provide 2 changes you have implemented since the implementation of KAS?

• Provide 2 success since the implementation of KAS?

the impact of the new kidney allocation system on donation and transplantation in region 5

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