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

For correspondence email: LSuplee@donors1.org

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