CI Forum graphic with date

OCTOBER 21-22, 2016

Purpose
The Organ Donation and Transplantation Alliance (The Alliance) invites key hospital system, transplant, OPO and physician/surgical leaders to convene for a 1 ½ day national critical issues forum. The primary goal of this event is to identify novel collaborations and strategies to increase the number of transplants done in the United States. Expert leaders will discuss the science of decision-making as it relates to organ utilization, and analyze how existing practice patterns may limit the number of transplants performed. Examples of unconventional strategies implemented by transplant centers, organ procurement organizations, and hospitals that have been successful in expanding organ utilization will be presented and discussed. This Forum will allow for an interactive environment so crucial conversations can occur and normative behaviors can be disrupted. Working groups will be formed to identify mutual and transferable solutions that can be implemented at all OPOs and transplant programs across the nation.

  • Background

    Background
    In keeping with the spirit of the National Organ Donation and Transplantation Breakthrough Collaboratives, which proved that focused and deliberate efforts can result in successful accomplishments toward a common goal, this Forum will bring together all three partners – OPOs, transplant centers and hospitals – to learn from each other and identify solutions to expand organ utilization. Building upon the workgroup conversations and meetings that have taken place to date around this issue, this Forum will be unique in that it will provide an environment to analyze and understand the decisions we make which may positively or negatively impact organ utilization. It is designed to establish collaborative relationships and strategies that may be carried forward after this important event.

    This interactive Forum will focus on problem solving and building successful strategies to increase organ utilization, in the current regulatory and financial environment. With the ongoing discussions about policy and regulatory changes around the issue of organ utilization, there is an imminent need to collaboratively evaluate the successful and unsuccessful practices that drive our decisions and outcomes. It is time for us to learn from those who have implemented effective practices and strategies and to transfer these to our own practices. The organ donation and transplantation community must not be encumbered by future policy changes and must realize that effective practices can be implemented regardless of current or impending policy change. In fact, implementing successful practices may be the precursor that is necessary to drive effective policy and regulatory changes.

  • What Does the Data Show?

    Overview of Organ Acceptance: (Feb 2015 – Jan 2016) – Based on OPTN data as of February 26, 2016

    PercentagePrimaryOrganOffersAcceptedbyMonth

     

    NationalMedianKDPIScoresByMonth

     

    In reviewing the Observed to Expected (O:E) yield per organ, it is evident that there are opportunities to raise the performance of increasing organ utilization at many organizations:

    OE_Organs

    Organs recovered for transplant and not transplanted should be examined for an opportunity to increase organ utilization.

    OrgansRecoveredTxNotTx

    VariationOrgansTxNotTx

     

     

     

     

     

     

     

    When reviewing data, it is important to note that kidneys and liver are usually defined as recovered for transplant but not transplanted, thoracic organs are typically not recovered. Comparing the U.S. kidney discard rates to countries in Europe, there are opportunities to explore how to improve our organ utilization rates:

    KidneyDiscards_US

    American Journal of Transplantation, pages 11-46, 11 JAN 2016 DOI: 10.1111/ajt.13666, http://onlinelibrary.wiley.com/doi/10.1111/ajt.13666/full#ajt13666-fig-0013

    DiscardComparisons

    (image shared with permission)

     

    To review organ specific flowcharts describing what happens to the organs, review pages 21-26 in a recently published report by the SRTR. Click on this link: http://onlinelibrary.wiley.com/doi/10.1111/ajt.13673/suppinfo – download the zip file by clicking on “ajt13673-sup-0001-SupInfo.zip” and open the pdf file.

     

    Lungs – Rates of organs recovered for transplant and not transplanted:

    Lungs

    American Journal of Transplantation, pages 141-168, 11 JAN 2016 DOI: 10.1111/ajt.13671

    Lung Transplants
    American Journal of Transplantation, pages 141-168, 11 JAN 2016 DOI: 10.1111/ajt.13671

    Patient survival among lung transplant recipients aged 12 years or older, 2007-2009
    American Journal of Transplantation, pages 141-168, 11 JAN 2016 DOI: 10.1111/ajt.13671

     

     

    Hearts – Rates of organs recovered for transplant and not transplanted:
    Heart
    American Journal of Transplantation
    pages 115-140, 11 JAN 2016 DOI: 10.1111/ajt.13670

    Heart Transplants
    American Journal of Transplantation
    pages 115-140, 11 JAN 2016 DOI: 10.1111/ajt.13670

    Patient survival among adult heart transplant recipients, 2007-2009
    American Journal of Transplantation
    pages 115-140, 11 JAN 2016 DOI: 10.1111/ajt.13670

     

    Intestine – Rates of organs recovered for transplant and not transplanted:

    IntestineAmerican Journal of Transplantation
    pages 99-114, 11 JAN 2016 DOI: 10.1111/ajt.13669

    Intestine Transplants
    American Journal of Transplantation
    pages 99-114, 11 JAN 2016 DOI: 10.1111/ajt.13669

    Graft survival among intestine transplant recipients, 2009
    American Journal of Transplantation
    pages 99-114, 11 JAN 2016 DOI: 10.1111/ajt.13669

     

    Liver – Rates of organs recovered for transplant and not transplanted:

    liver
    American Journal of Transplantation
    pages 69-98, 11 JAN 2016 DOI: 10.1111/ajt.13668

    Liver Transplants
    American Journal of Transplantation
    pages 69-98, 11 JAN 2016 DOI: 10.1111/ajt.13668

    Graft survival among adult liver transplant recipients, 2009: deceased donors
    American Journal of Transplantation
    pages 69-98, 11 JAN 2016 DOI: 10.1111/ajt.13668

     

    What is the outcome for using “extended” kidneys and how does this data compare to the mortality rates for waitlisted candidates?

    Extended Kidney

    American Journal of Transplantation
    pages 11-46, 11 JAN 2016 DOI: 10.1111/ajt.13666
    http://onlinelibrary.wiley.com/doi/10.1111/ajt.13666/full#ajt13666-fig-0030

    Kidney Mortality Rates

     

    Where are the possible windows of opportunity to improve kidney utilization?

    kidneyutilization

  • Learning Objectives

    Learning Objectives

    • To identify effective and scalable practices to increase organ utilization
    • To identify opportunities to disrupt current practice patterns and evaluate how existing policies  that may impede organ utilization
    • To implement strategies to enhance techniques and provide economic incentives to increase organ utilization
    • To examine the science of decision making as it applies to current organ utilization practices and strategies

  • Forum Outcomes

    Forum Outcomes

    • Attendees will gain knowledge and understanding about the science of decision making and how it affects their practices within their organizations.
    • Develop a consensus document outlining effective practices and successful strategies.
    • Participants will agree to address identified biases and decision making practices and commit, where possible, to implementing new practices identified at this Forum.

  • Program Details

    Program Details

    Download agenda here.

    Friday, October 21, 2016
    Day 1 Program
    Time Program
    7:15 – 8:00am Registration / Continental Breakfast
    Morning Session – Panel Presentations
    8:00 – 8:10am Welcome & Framing
    8:10 – 8:45am The Science of Decision Making and its Implications
    Better understand the science of decision-making and its impact on our practice. The principles learned during this session will be used to analyze and evaluate our own practice patterns to identify opportunities for increasing organ utilization and transplantation.
    8:45 – 9:45am Risk Adjustment, Listing Practices, and Acceptance Rates: Is there a Disconnect?

    • How “risk” is accounted for in outcomes evaluations.
    • Program acceptance practices and transplant outcomes with respect to risk
    • Opportunities to increase organ placement efficiency through consistent listing and acceptance practices
    9:45 – 10am Networking Break
    10 – 10:45am Where are the Opportunities to Increase Transplantation?
    Hear from panelists about the opportunities they have identified to increase transplantation.
    • The Region 8 and National Experience & Analysis
    • Why do we send out our kidneys?
    10:45 – 12:15pm How Can We Disrupt the Status Quo without Impacting Outcomes? – A Panel Presentation and Discussion
    Learn from key leaders who disrupted the status quo and are identifying novel approaches to maximize organ utilization. Financial, regulatory and ethical considerations and the impact on number of lives saved will be discussed.
    • Fracking Hard
    • Searching for Opportunity in Heart Transplantation
    • Pushing the Boundaries in Kidney Transplantation
    • Center Level Approach to Increasing Living Kidney Donor Transplant Performance
    12:15 – 12:30pm Q&A / Instructions for Breakout Workgroup Discussions
    12:30 – 1:15pm Lunch
    Interactive Breakout Discussion Workgroups
    Facilitated Workgroup Discussions:
    The goal of the workgroup discussions is to learn from the successful examples presented in the morning sessions, identify new ones and combine them with personal experiences to identify opportunities for change within the confines of the current regulatory and policy expectations. A compilation of these successful strategies will be created and presented to all Forum attendees on Day 2 when commitments to action will be sought.
    Group A
    1:15 – 3:00pm
    Group A: Technical Considerations of Organ Utilization

    • How can recipient selection practices facilitate the optimization of organ utilization?
    • How can geographic barriers be minimized through different approaches to practices, resulting in the utilization of more organs?
    • Which organ evaluation practices could expedite or facilitate more effective organ utilization?
    • Which communication practices and strategies foster an increase in organ utilization?
    • Which data references can facilitate the evaluation of organ utilization practices?
    Group B
    1:15 – 3:00pm
    Group B: Economical Considerations of Organ Utilization

    • Which activities could facilitate the navigation of public perception with regard to organ utilization?
    • What are the ethical considerations and implications on practice with regard to organ allocation and utilization?
    • What are the economic issues related to managing patients who have received the higher risk organs, whether resources or actual expenses (personnel, LOS concerns, etc.), and should these economic issues guide and influence decision-making?
    • What factors are of concern from a cost perspective, either from the OPO or transplant center, that impact decision making that hinder organ utilization and which approach and/or perspective could help to facilitate organ utilization?
    • What opportunity exists to have different reimbursement models that would allow for cost/risk sharing with insurance carriers for higher organ utilization with higher risk organs?
    3:00 – 3:20pm Networking Break
    3:20 – 5:00pm Workgroup facilitated discussions (continued)/ Wrap-up/ Framing Day 2
    Groups A&B
    5:30 – 7:00pm Networking Reception

     

    Saturday, October 22, 2016
    Day 2 Program
    Time Program
    7:30 – 8:30am Continental Breakfast / Networking
    8:30 – 9:30am Report Outs & Consensus Building
    Workgroup Reports, Sharing of Best Practices, Consensus Discussion
    9:30 – 9:45am Networking Break
    9:45 – 10:45am Report Outs & Consensus Building (cont’d)
    Workgroup Reports, Sharing of Best Practices, Consensus Discussion
    10:45 – 11:45am Agreements & Commitments
    Consensus Solutions, Next Steps, Commitments
    11:45 – 12:00pm Leave in Action

  • Critical Issues Forum Planning Members

    We want to thank our planning team:

    • Angie Korsun, Chief Administrative Officer,  The University of Iowa Hospitals and Clinics, Iowa
    • Charlie Alexander, Chief Executive Officer, The Living Legacy Foundation, Maryland
    • Christopher Sonnenday, MD, Surgical Director of Liver Transplantation, University of Michigan Medical Center, Michigan
    • James Pittman, Assistant Vice President of Transplant Services, HCA System, Tennessee
    • Jeff Orlowski, Chief Executive Officer, LifeShare Transplant Donor Services of Oklahoma, Oklahoma
    • Kevin Cmunt, Chief Executive Officer, Gift of Hope, Illinois
    • Kevin Myer, Chief Executive Officer, LifeGift, Texas
    • Luke Preczewski, Executive Director, University of California Davis Medical Center, California
    • Richard Gilroy, MD, Medical Director of Liver Transplantation, University of Kansas Medical Center, Kansas
    • The Alliance Team

Target Audience
This forum is limited to senior level hospital, transplant center, OPO and physician/surgical leaders who can affect change within their organization. This includes hospital and transplant administrators, OPO executives and medical and surgical directors. Seating is limited to encourage productive group discussion and the identification of strategic outcomes.