John Abrams; Lawrence Suplee; Howard M. Nathan; Richard Hasz; Sharon West
Gift of Life Donor Program, Philadelphia, PA
Presented by:
Lawrence Suplee
OPO Allocation Protocol Reduces Cadaveric Kidney Cold Ischemic Time
Gift of Life Donor ProgramPhiladelphia, Pennsylvania USA
• Non-Profit OPO/Tissue Recovery/Eye Bank • Established in 1974• Federally designated OPO (by Medicare) for
eastern PA, Southern NJ & Delaware- 130 Acute Care Hospitals
- 15 Transplant Centers, 43 Programs - 10.3 Million Population
• 2011* Projected Data: - 440 Organ Donors / 42.7 Donors/MM - 1,236 Bone Donors and 2,551 Cornea Donors
• Over 31,000 organs for transplantation and over 375,000 tissue allografts
• Accredited by: Association of Organ Procurement Organizations (AOPO); American Assoc. of Tissue Banks (AATB) & Eye Bank Assoc. of America (EBAA); UNOS/OPTN member OPO
*Source: Gift of Life data. 2011 Projection Based on YTD performance through 11/15/2011
Introduction & Purpose
Cold Ischemic TimeCold Ischemic Time
Renal Distribution TimeRenal Distribution Time
HLA
List Alloca
te
Final XM
Give Away
TXP
Transplant Center TimeTransplant Center Time
Transp
ortatio
n
Renal Distribution Time (RDT) (OPO driven)RDT is defined as the time from cross-clamp to when a kidney is available to a center for a specific recipient including complete donor history and compatible final crossmatch.
Transplant Center Time (TxT) (Center driven)TxT is defined as the time a center requires to implant the kidney from renal distribution time.
Blood routinely sent to all local HLA Labs
Final crossmatches performed by all local Transplant Centers
Specialized OPO renal allocation staff initiate kidney distribution
Couriers alerted and present at donor hospital to transport kidneys to accepting center
HLA identification process starts using peripheral blood immediately after family consent
Im
prov
ing
Ren
al
Dis
trib
utio
n T
imes
Results: Renal Distribution Times (RDT)2006 to 2010
DCD 465 8'53" 6'46" 4'12" - 9'44" 16'00"
ECD 461 3'36" 9'58" 3'48" - 8'41" 12'34"
SCD-F 313 2'59" 7'45" 3'45" - 10'01" 12'00"
SCD-NF 1,077 2'45" 7'29" 4'58" - 8'49" 12'00"
Overall 2,316 3'43" 7'22" 4'44"- 8'54" 13'00"
Donor Type
Median CIT
Median TxT by Center
(n=15 Centers)
Median TxT
Median RDT
Kidneys Txd
2006 2007 2008 2009 20102
4
6
8
10
12
14
4.6 4.6
43.2 2.8
7.7 7.4
8.7
7.77.9
13
14
1312.6
11.2
RDT TxT CIT
ECD Median Times (Hours)2006 – 2010
2006 2007 2008 2009 20102
4
6
8
10
12
14
5.14.6
2.9 2.52
7.6 7.3
8.78.2
7.7
1312.8
1211.8
10
RDT TxT CIT
SCD Median Times (Hours)2006 – 2010
4 to 6 6 to 8 8 to 10 10 to 12 12 to 14 14 to 16 16 to 18 18 to 20 20+0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
15% 15%
19%
31%
37%39%
46%
37%
44%
CIT (Hours)
AT
N R
ate
Local SCD Kidney ATN Rates by CIT 2006 – 2010
4 to 6 6 to 8 8 to 10 10 to 12 12 to 14 14 to 16 16 to 18 18 to 20 20+0%
10%
20%
30%
40%
50%
60%
70%
42%
36% 36%
46%
37%
56%
47%45%
62%
CIT (Hours)
AT
N R
ate
Local ECD Kidney ATN Rates by CIT 2006 – 2010
Conclusion• OPO re-design of core process for renal allocation
reduced median CIT by • SCD by 3 Hours 23% (actual time)• ECD by 1.8 Hours 14% (actual time)
• OPO reduction in renal distribution time (RDT) by:• 61% (SCD) to 2 hours• 39% (ECD) to 2.8 Hours
• Median TxT (from 15 centers) varied by center from 4’ 44” to 8’ 54”
• Transplant centers should examine their practices after accepting a kidney to ensure lowest possible CIT
• OPOs should measure RDT to improve kidney allocation