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Deceased organ donors in United States exceeded 10,000 for first time in 2017

During 2017, the number of deceased organ donors in the United States topped 10,000 for the first time, according to preliminary data from United Network for Organ Sharing (UNOS), which serves as the national Organ Procurement and Transplantation Network (OPTN) under federal contract. For the year, organs were recovered from 10,281 donors, representing a 3.1 percent increase over 2016 and an increase of 27 percent since 2007.

A total of 34,768 organ transplants were performed in 2017 using organs from both deceased and living donors, according to preliminary data. This total is a 3.4 percent increase over 2016 and marks the fifth consecutive record-setting year for transplants in the United States. Record number of donor organs were recovered and transplants occurred for each of the four most common organs transplanted – kidney, liver, heart and lung.

“We are grateful that more lives are being saved, year after year, thanks to the boundless generosity of organ donors,” said Yolanda Becker, M.D., president of the OPTN/UNOS Board of Directors. “We remain committed to increasing the number of transplants still further to help the many thousands of people in need of a transplant to sustain them and vastly improve their quality of life.”

Approximately 82 percent (28,587) of the transplants performed in 2017 involved organs from deceased donors. Living donor transplants accounted for the remaining 18 percent (6,181). In the 30-year span from 1988 (the first full year national transplant data were collected) through 2017, a total of 721,742 transplants have been performed nationwide.

While the number of potential organ donors varies among different areas of the country due to differences in population size and medical characteristics, increases were noted in many areas. Of the 58 organ procurement organizations (OPOs) coordinating deceased organ donation nationwide, 35 (60 percent) experienced an increase in donors from 2016 to 2017, including at least one OPO in each of UNOS’ 11 regions.

“Donation and transplantation continues to increase across the country,” said Brian Shepard, Chief Executive Officer of UNOS. “We are working with donation and transplantation professionals nationwide to help identify additional transplant opportunities and enhance the efficiency of the organ acceptance process.”

Broadening of clinical criteria for potential donors accounts for some of the ongoing increase in deceased organ donation and transplantation. In 2017, as compared to 2016, a higher proportion of donors had medical characteristics such as donation after circulatory death as opposed to brain death, drug intoxication as a mechanism of death, age of 50 or older, and/or being identified as having increased risk for blood-borne disease.

“As we increase our understanding of medical criteria that contribute to successful transplantation, donation and transplantation professionals have been able to use organs from a wider set of potential donors,” said David Klassen, M.D., UNOS Chief Medical Officer. “In doing so, we continue to carefully balance the opportunity for transplantation with a commitment to maintaining patient safety.”

United Network for Organ Sharing (UNOS) serves as the national Organ Procurement and Transplantation Network (OPTN) under contract with the Department of Health and Human Services, Health Resources and Services Administration. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.


We can all help

We can all help

For Kaci Alvarado, an ordinary Saturday of running errands resulted in an extraordinary act of kindness. The last task on her list that day was to have an oil change at a friend’s auto repair shop. While Kaci was there, her friend asked her to proofread a Facebook post she was writing about another good friend, Michael, who was ill and needed a kidney transplant. While reading through the post, Kaci realized that she had the same blood type as Michael. She told her friend that she was willing to donate, and testing started immediately.

Kaci donated her kidney in June 2013. She remains in contact with Michael, who lives in Houston with his family. Kaci’s giving spirit is an inspiration to her son, Austin, 16, and daughter, Bethanie, 13. After their mother’s donation, Austin and Bethanie have a new definition of hope.

“Organ donation showed me that we all can help in some way,” says Austin. “I think it is helpful to those who are sick and need a second chance.”

Kaci’s gift motivated Bethanie to also register as a donor when she is old enough.

“I think it’s amazing that a person can choose to donate a part of themselves to save a life,” she said. “Seeing how donating an organ can change the recipient’s life for the better has inspired me.”

Both kids aspire to help others when they grow up, like their mother has. Austin dreams of one day becoming a forensic anthropologist to study unidentified bones, and Bethanie hopes to become a nurse so she can care for elderly people in nursing homes.

Kaci is also still offering hope and changing lives. Currently an office assistant to a psychiatrist in Weatherford, Texas, she is going back to school to become a transplant coordinator.


Be more

Be more

On April 2, 2016 Erin and I met and built a one of a kind friendship after being turned down by one hospital to become her organ donor. So passionate about continuing to spread the word on donation and its importance we never let the idea of encouraging others to “be more” in this life come to an end. Since then, Erin chose to get on another hospital’s list in search of her life saving organ.

Breanna and Erin, living kidney donationWithout hesitation, I enrolled immediately to try again. I knew my purpose in her life wasn’t complete just yet. A rollercoaster of emotions later, we finally got the answer we have prayed so long for. It was me. I was going to be Erin’s donor. I was going to be able to give her the life she deserves with her family and hopefully to start one of her own with her husband, Rich. On September 12, 2017, we underwent our surgery. Her new kidney worked immediately and her dialysis port was removed. We are now one-month post-op and happier than ever. Donation isn’t easy, but I would do it all over again in a heartbeat to see that giant smile on Erin’s face as I walked to her one-day post-op. My heart overflows with emotion and my life has gained so much more purpose. I may have saved her life, but Erin and God truly saved mine by trusting me to be more in this world.


Board approves enhanced liver distribution system

Atlanta – The OPTN/UNOS Board of Directors, at its meeting December 4, approved a set of policy amendments to reduce geographic differences in liver transplant candidates’ access to a timely transplant.

“Today’s action is an important step in enhancing equity for liver transplant candidates nationwide,” said Yolanda Becker, M.D., president of the OPTN/UNOS Board of Directors.  “For many years, there have been considerable differences from one area of the country to another in terms of how sick most liver candidates need to be before they are likely to get a transplant.  The revised policy reduces the effect of geography on transplant access and puts more appropriate emphasis on medical criteria that save and lengthen lives.”

The policies approved by the Board include the following key provisions:

  • Additional transplant priority (equivalent to 3 MELD or PELD points) will be awarded to liver candidates with a MELD or PELD of at least 15, and who are either within the same donor service area (DSA) as a liver donor or are within 150 nautical miles of the donor hospital but in a different DSA.
  • Adult candidates who have a calculated MELD score of 32 or higher, as well as pediatric candidates younger than age 18 with a MELD or PELD score of 32 or higher, would be prioritized for organ offers.
  • Livers from deceased donors who are age 70 or older, or who die of cardiorespiratory death, would not be subject to offers to the expanded DSA plus proximity circle.  Livers from donors with these medical characteristics are most often transplanted at hospitals nearby to the donor hospital.

Simulation modeling of the likely effects of the revised system suggests it will decrease pre-transplant deaths among liver candidates and increase transplant access for candidates younger than age 18.  The modeling does not suggest the system will greatly affect transplant access based on candidates’ insurance type (public or private). Similarly, the modeling does not suggest the system will greatly affect transplant access whether candidates live in urban settings as opposed to suburban/rural areas.

“We will closely study the effects of the system, even prior to implementation and continuing as long as it remains in place,” added Dr. Becker.  “Every transplant policy is reviewed for intended and unintended effects.  Through the OPTN policy-making process, we’ll continue to seek ways to make the policy work most effectively and address any issues that suggest it’s not giving everyone similar benefit.”

The action is the result of a five-year process of study and discussion.  (See a timeline of key events in development of liver policy.)  The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee held two public forums and considered several distribution concepts.  The proposal approved by the Board was initially distributed for public comment in July 2017; several details were amended as a result of public input.

An implementation date for the new system has yet to be established; it will require time to allow for system programming and testing, as well as education for donation and transplantation professionals.

United Network for Organ Sharing (UNOS) serves as the national Organ Procurement and Transplantation Network (OPTN) under contract with the Department of Health and Human Services, Health Resources and Services Administration. The OPTN brings together medical professionals, transplant recipients and donor families to develop national organ transplantation policy.


At two years, HOPE Act still offering hope

Two years since its implementation, the HIV Organ Policy Equity Act (also known as the HOPE Act) has continued to provide transplant opportunities for candidates with HIV who are willing to accept organ offers from HIV-positive donors.

As of November 20, 2017, 34 transplants had been performed at six hospitals participating in HOPE Act protocols. This included 23 kidney transplants and 11 liver transplants, involving organs from 14 deceased donors.

“This is a significant advance in organ donation and utilization,” said Cameron Wolfe, M.D., chair of the OPTN/UNOS Ad Hoc Disease Transmission Advisory Committee. “While the early trend in transplants remains somewhat modest, people living with HIV are able to be organ donors, where for decades they were prohibited from doing so. I have worked with patients who feel empowered by the idea of one day being a donor for another person living with HIV. And transplanting organs from these donors into HIV-positive candidates also means more organs from HIV-negative donors are available for HIV-negative recipients.”

The HOPE Act, signed into law Nov. 21, 2013, called for the use of organs from HIV-positive donors for transplantation into HIV-positive candidates under approved research protocols designed to evaluate the feasibility, effectiveness and safety of such organ transplants. The provisions of the Act were made effective on Nov. 21, 2015.

As of November 20, 2017, 22 transplant hospitals have enrolled with the OPTN to participate in HOPE Act research, and approximately 200 candidates are currently listed as consenting to receive organ offers from HIV-positive donors.

Any participating hospital must conduct transplants under IRB-approved research protocols conforming to the Final Human Immunodeficiency Virus (HIV) Organ Policy Equity (HOPE) Act Safeguards and Research Criteria for Transplantation of Organs Infected with HIV, which were developed by the National Institute of Allergy and Infectious Diseases, one of the National Institutes of Health.

Organ procurement organizations are able to run matches for HIV-positive donors. The only candidates who will appear on match runs for these donor offers will be those listed at transplant programs that have an IRB-approved protocol, and whose HIV status and willingness to accept an HIV positive kidney or liver has been confirmed.

“The transplant community is closely monitoring outcomes of these transplants, both to ensure the safety of patients involved and to see whether their transplant outcomes are similar to recipients of HIV-negative organs,” said Dr. Wolfe. “This information will help the transplant community understand the impact of using HIV-positive donor organs and how we can help patients make decisions that offer them the most benefit.”

Learn more about the HOPE Act and related OPTN policy. See additional data and information in this Transplant Pro article.


Policy modification to lung distribution sequence


Effective at 8 p.m. Eastern time, November 24, 2017, the OPTN lung allocation system was modified to replace the donor service area (DSA) as the first level of distribution with a 250 nautical mile circle around the donor hospital.  The OPTN/UNOS Executive Committee authorized this action in response to an emergent directive from the Secretary of the U.S. Department of Health and Human Services.


On Monday, November 20, the U.S. Department of Health and Human Services (HHS) directed the OPTN to conduct an emergent review of lung allocation policy.  HHS requested the OPTN to review and address by Friday, in response to a court-ordered deadline, the rationale for using the DSA as the first level of distribution, given the arbitrary nature of DSA boundaries and the potential that urgent transplant candidates in close proximity to organ donors may not get immediate priority if they are across a DSA boundary.

The OPTN/UNOS Executive Committee deliberated the HHS directive, with input from the OPTN/UNOS Thoracic Organ Transplantation Committee.  While geographic proximity of donors and recipients is linked to successful lung transplant outcomes due to ischemic time constraints, DSAs vary considerably in size and population.

The Executive Committee responded to the HHS directive by a unanimous vote on November 24 to approve a policy proposal that maintains the concentric circle approach used in thoracic allocation policy and allows for local utilization, but with a more consistent approach than using DSAs as the initial distribution area.  The Committee proposed to HHS that a circle of 250 nautical miles surrounding the donor location would best address the critical comment.  HHS has accepted this solution.

While the Executive Committee can act on emergent policy issues, any policy action the committee makes is subject to additional review and potential revision through the OPTN policy-making process.  The policy is set to expire in one year to allow the Thoracic Organ Transplantation Committee to study the effects of the policy revision and make additional recommendations, including public comment, to the OPTN/UNOS Board of Directors.

Implications for members

This revision affects only the initial distribution sequence of organ offers for lung candidates.  It does not affect any other provisions in policy, such as LAS scores, donor and candidate testing, diagnosis groups or reporting of data.  After candidates receive offers within a 250-mile radius, there is no change to additional distribution zones (A, B and C).

Any organ offers that precede the time of implementation should continue according to the sequence as identified on the original match run, even if the offer process continues after the implementation of the new sequence.

Depending on the association between donor and candidate locations, some areas will experience changes in candidates prioritized on local matches, potentially including a higher number of lung offers.  We encourage OPOs and transplant centers to work together in a time-sensitive manner to minimize the likelihood of organ wastage.

For further information

Please contact your Regional Administrator if you have questions.