OPTN Modifications to Heart Allocation Policy Implemented July 12, 2006 Changed the allocation order for medically urgent (Status 1A and 1B) patients Policy

OPTN

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 Local Status 2 Zone A Status 1A Zone A Status 1B Zone A Status 2 Zone B Status 1A Zone B Status 1B Etc.

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.

OPTN

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

OPTN

Composition of Heart Waiting List by Medical Urgency

7/5/2006 – 9/19/2007

0

500

1,000

1,500

2,000

2,500

3,000

7/5/

2006

8/2/

2006

9/6/

2006

10/4

/200

6

11/1

/200

6

12/6

/200

6

1/3/

2007

2/7/

2007

3/7/

2007

4/4/

2007

5/2/

2007

6/6/

2007

7/4/

2007

8/1/

2007

9/5/

2007

9/19

/200

7

Snapshot date

Nu

mb

er

of can

did

ates

Status 1A Status 1B Status 2 Status 7

Based on OPTN data as of September 21, 2007

OPTN

Number of Active Heart Candidates on the Waiting List by Week and Region

7/5/2006 – 9/19/2007

0

50

100

150

200

2507/5

/2006

8/5

/2006

9/5

/2006

10/5

/2006

11/5

/2006

12/5

/2006

1/5

/2007

2/5

/2007

3/5

/2007

4/5

/2007

5/5

/2007

6/5

/2007

7/5

/2007

8/5

/2007

9/5

/2007

Nu

mb

er

of

can

did

ate

s

1 2 3 4 5 6 7 8 9 10 11


OPTN

Heart Transplants by recipient age group7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007

197126

1901

214107

1884

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

0-10 Years 11-17 Years 18+ Years

Nu

mb

er o

f T

ran

spla

nts

7/12/05-7/11/06 (N=2224) 7/12/06-7/11/07 (N=2205)


OPTN

Heart Transplants by Status7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007

894775

555

1039

827

339

0

200

400

600

800

1,000

1,200

Status 1A Status 1B Status 2

Nu

mb

er o

f T

ran

spla

nts

7/12/05-7/11/06 (N=2224) 7/12/06-7/11/07 (N=2205)


OPTN

Heart Transplants by Geographic Location7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007

1323

702

175

19 5

1064944

177

14 60

200

400

600

800

1,000

1,200

1,400

Local Zone A Zone B Zone C Zone D

Nu

mb

er o

f T

ran

spla

nts

7/12/05-7/11/06 (N=2224) 7/12/06-7/11/07 (N=2205)


OPTN

Heart Transplants by Geographic Location and Medical Urgency Status

7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007

20.6 18.5 21.4 21.817.4

7.9

15.524.3

10.412.9

5.7

5.7

4.1

4.4

32.8

1.8

1.8

0

5

10

15

20

25

30

35

40

45

50

Pre Post Pre Post Pre Post

Per

cen

t o

f T

ran

spla

nts

Local Zone A Other



OPTN

Heart Transplants by Region7/12/2005-7/11/2006 vs. 7/12/2006-7/11/2007

0

50

100

150

200

250

300

350

400

1 2 3 4 5 6 7 8 9 10 11

Nu

mb

er o

f T

ran

spla

nts

7/12/05-7/11/06 7/12/06-7/11/07


OPTN


Region 1

0102030405060708090

100

Pre Post

Nu

mb

er o

f T

ran

spla

nts


72

87


OPTN


Region 2

0

50

100

150

200

250

300

350

Pre Post

Nu

mb

er o

f T

ran

spla

nts


269

326


OPTN


Region 3

0

50

100

150

200

250

300

350

Pre Post

Nu

mb

er o

f T

ran

spla

nts


277

287


OPTN


Region 4

0

50

100

150

200

250

Pre Post

Nu

mb

er o

f T

ran

spla

nts


208 210


OPTN


Region 5

0

50

100

150

200

250

300

350

400

Pre Post

Nu

mb

er o

f T

ran

spla

nts


364 362


OPTN


Region 6

0

10

20

30

40

50

60

70

Pre Post

Nu

mb

er o

f T

ran

spla

nts


54

66


OPTN


Region 7

0

50

100

150

200

250

Pre Post

Nu

mb

er o

f T

ran

spla

nts


201210


OPTN


Region 8

0

20

40

60

80

100

120

140

160

180

Pre Post

Nu

mb

er o

f T

ran

spla

nts


152 155


OPTN


Region 9

020406080

100120140160180200

Pre Post

Nu

mb

er o

f T

ran

spla

nts


175142


OPTN


Region 10

0

50

100

150

200

250

Pre Post

Nu

mb

er o

f T

ran

spla

nts


220

171


OPTN


Region 11

0

50

100

150

200

250

Pre Post

Nu

mb

er o

f T

ran

spla

nts


231

191


OPTN


Region 1

0

10

20

30

40

50

60

70

80

90

Pre Post Pre Post

Nu

mb

er o

f T

ran

spla

nts


CTOP MAOB

49

6878


OPTN


Region 2

0

20

40

60

80

100

120

140

Pre Post Pre Post Pre Post Pre Post Pre Post

Nu

mb

er o

f T

ran

spla

nts


DCTC MDPC


10

4436

57

48

18

79

58

124120

NJTO PADV PATF

OPTN


Region 3

0

10

20

30

40

50

60

70

80

Nu

mb

er o

f T

ran

spla

nts


ALOB AROR


2720

30 28 2626

6967 57

49

FLMP FLUF FLWC GALL LAOP MSOP PRLL

45 46

2217

4 613 12

OPTN


Region 4

0102030405060708090

100

Pre Post Pre Post Pre Post Pre Post

Nu

mb

er o

f T

ran

spla

nts


OKOP TXGC TXSBTXSA


23

32

77 77

25

15

8683

OPTN


Region 5

020406080

100120140160180200

Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post

Nu

mb

er o

f T

ran

spla

nts


AZOB CAGS UTOPCAOPCADN CASD


53

1

92 93

4

53

175162

16 13

4028

OPTN


Region 6

0

5

10

15

20

25

30

35

40

45


Nu

mb

er o

f T

ran

spla

nts


HIOP ORUO WALC


1

31

22 23

1

41

OPTN


Region 7

0102030405060708090

100

Pre Post Pre Post Pre Post Pre Post

Nu

mb

er o

f T

ran

spla

nts


ILIP MNOP WIUWWISE


77

39

65 63

40

90

1819

OPTN


Region 8

0

10

20

30

40

50

60

70


Nu

mb

er o

f T

ran

spla

nts


CORS IAOP MOMA MWOB NEOR


30

50

6 9

59

33

1419

40

47

OPTN


Region 9

0

20

40

60

80

100

120

140

160


Nu

mb

er o

f T

ran

spla

nts


NYAP NYFL NYRT


10

147

17 11

3

126

OPTN


Region 10

0

10

20

30

40

50

60

70

80


Nu

mb

er o

f T

ran

spla

nts


INOP MIOP OHLB OHLP OHOV


32

7571

35

64

38

14192022

OPTN


Region 11

0

10

20

30

40

50

60

70

Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post

Nu

mb

er o

f T

ran

spla

nts


KYDA NCCM NCNC SCOP TNDS TNMS VATB


2619

2023

62

2220

54

34

26

13 13

57

37

OPTN

Preliminary Results for Death Per 100 Years on the Waiting List: All Statuses Combined

11/12/2005-7/11/2006 vs. 7/12/2006-3/11/2007

15.7

27.4

14.511.9

20.2

11

0

5

10

15

20

25

30

All Ages 0-17 18+

Dea

ths

Per

100

Pat

ien

t Y

ears

11/12/05-7/11/06 7/12/06-3/11/07

Based on OPTN data as of July 6, 2007

* Deaths include those reported to the OPTN or to SSDMF while on waiting list or < 7 days of non-transplant removal.

OPTN

Preliminary Results for Death Per 100 Years on the Waiting List: All Ages Combined

11/12/2005-7/11/2006 vs. 7/12/2006-3/11/2007

96.3

20.3

5.8

30.3

11.83.7

0

20

40

60

80

100

120


Dea

ths

Per

100

Pat

ien

t Y

ears

11/12/05-7/11/06 7/12/06-3/11/07

Based on OPTN data as of July 6, 2007

* Deaths include those reported to the OPTN or to SSDMF while on waiting list or < 7 days of non-transplant removal.

OPTN

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.

OPTN

OPTN

Modifications to Kidney Allocation Policy – Pediatric Priority for

Donors < 35 years 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.

OPTN

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

OPTN

Deceased Donor Kidney TransplantsBy Donor Age and Recipient Age

3/28/04 – 9/27/05 vs. 9/28/05 – 3/27/07

67 104 80 128

288

601

17 2 175

104

11

0

100

200

300

400

500

600

700


Nu

mb

er

of

Tra

ns

pla

nts

Donors 0-34 Donors 35 +

Age 11-17Age 0-5 Age 6-10

OPTN

Deceased Donor Kidney Transplants, 3/28/04 – 3/27/07By Time Period, Donor Age and Recipient Age

67104

80128

288

601

172

175

104

11

7,827 8,701

5,3785,653

0%

20%

40%

60%

80%

100%

3/28/04 -9/27/05

9/28/05 -3/27/07

3/28/04 -9/27/05

9/28/05 -3/27/07

3/28/04 -9/27/05

9/28/05 -3/27/07

3/28/04 -9/27/05

9/28/05 -3/27/07

Donors 0-34 Donors 35 +

Age 0-5 Age 18+Age 11-17Age 6-10

OPTN

Kidney Transplants, 3/28/04 – 3/27/07By Period, Donor Type and Recipient Age

84106 97

133392

612

165126 111

74365

2639,393 9,015

14,07913,480

0%10%20%30%40%50%60%70%80%90%

100%

3/28/04 -9/27/05

9/28/05 -3/27/07

3/28/04 -9/27/05

9/28/05 -3/27/07

3/28/04 -9/27/05

9/28/05 -3/27/07

3/28/04 -9/27/05

9/28/05 -3/27/07

Deceased Living

Age 0-5 Age 18+Age 11-17Age 6-10

OPTN

Waiting List Removals during 3/28/04 – 3/27/06By Time Period and Age at Listing

662971

13,248 13,845

39

34

5,896 5,716

315238

6,2666,517

125 1308,259 10,929

0%10%20%30%40%50%60%70%80%90%

100%

3/28/04 - 9/27/05 9/28/05 - 3/27/07 3/28/04 - 9/27/05 9/28/05 - 3/27/07

Deceased Donor Tx Died Living Donor Tx Other

Age 0-17 Age 18+

OPTN

Percent Transplanted Within 12 MonthsWL Additions during 9/28/04 – 8/27/06By Policy Period and Age at Listing

51.448.4

11.6

51.2

11.8

42.839.5

51.953.7

44.1

0

10

20

30

40

50

60

0-5 6-10 11-17 All Peds Adults

Age at Listing

Pe

rce

nt

9/28/04-8/27/05 9/28/05 - 8/27/06

OPTN

Kidney Transplants, 3/28/04 – 3/27/07By Period, DR HLA MM Level and Recipient Age

92 703,588 3,401

281

384

5,731 5,947

200396

4,156 4,719

0%

20%

40%

60%

80%

100%

3/28/04 - 9/27/05 9/28/05 - 3/27/07 3/28/04 - 9/27/05 9/28/05 - 3/27/07

0 DR MM 1 DR MM 2 DR MM

Age 0-17 Age 18+

OPTN

Pediatric Kidney Waiting List Candidates at Month End for Jan 2005 – May 2007

613

605

629

613

597

591

589

547

527

500

495

475

506

489

446

428

406

414

422

426

451

427

424

407

428

442

427

196

190

203

209

221

227

261

266

272

274

281

286

286

317

323

334

324

309

322

320

317

318

326

318

329

337

610

596

184

180

199

0%

20%

40%

60%

80%

100%

Jan

05

Mar

05

May 0

5

Ju

l 05

Sep

05

No

v 0

5

Jan

06

Mar

06

May 0

6

Ju

l 06

Sep

06

No

v 0

6

Jan

07

Mar

07

May 0

7

Active Inactive

OPTN

Pediatric Additions during the Month and Active Pediatric Candidates Waiting at Month End,

Jan 2005 – May 2007

0

100

200

300

400

500

600

700

Ja

n 0

5

Ma

r 0

5

Ma

y 0

5

Ju

l 0

5

Se

p 0

5

No

v 0

5

Ja

n 0

6

Ma

r 0

6

Ma

y 0

6

Ju

l 0

6

Se

p 0

6

No

v 0

6

Ja

n 0

7

Ma

r 0

7

Ma

y 0

7

Active Candidates on the List Additions to the WL

OPTN

Kaplan-Meier Graft Survival by Policy PeriodPediatric Recipients of DD Kidney Transplants

during 9/28/04-9/27/06

60

65

70

75

80

85

90

95

100

0 3 6 12

Months Post-Transplant

Su

rviv

al

(%)

9/28/04-9/27/05 9/28/05-9/27/06

P-value = 0.21

OPTN

Kaplan-Meier Patient Survival by Policy PeriodPediatric Recipients of DD Kidney Transplants

during 9/28/04-9/27/06

60

65

70

75

80

85

90

95

100

0 3 6 12

Months Post-Transplant

Su

rviv

al

(%)

9/28/04-9/27/05 9/28/05-9/27/06

P-value = 0.76

OPTN

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.

OPTN

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.

Documents

OPTN Modifications to Heart Allocation Policy Implemented July 12, 2006 Changed the allocation order for medically urgent (Status 1A and 1B) patients Policy