UNOS/OPOs - AASLD

Carl L. Berg, MD
UNOS/OPO’s
No relationships to disclose.
Content of the presentation does not include discussion of off-label /
investigative use of medicine(s), medical devices, or procedure(s).

Transplant Hepatology Board Review:
OPO/UNOS
Carl L. Berg, MD
Interim Chief of GI/Hepatology
Associate Councilor UNOS Region 11
University of Virginia

UNOS/OPOs
• UNOS membership
• Liver transplant physicians
• RRB and MELD exception requests
• Multiple listing policies
• Transplant center survival statistics
• Board questions

Question 1
LifeNet is the sole OPO that serves the liver
transplant centers in Virginia based at
UVA and VCU. A patient comes to UVA to
be listed for liver transplantation and asks
whether it is possible to be listed on more
than one transplant center’s list. Which of
the following statements regarding
multiple liver transplant center listing is
correct

Question 1 Answers
a) It is not possible to be on more than one
liver transplant list at a time.
b) The patient may be listed at both UVA
and VCU to maximize his chance to
receive a transplant.
c) The patient may not be listed at both
UVA and UNC as UNC and UVA are is
both located in UNOS Region 11.
d) The patient may be double listed at UVA
and Georgetown as Georgetown is
located in a different OPO.

Question 2
A transplant physician believes that
his patient has a risk of waiting list
death that exceeds that predicted by
his MELD score. Which of the
following statements regarding
requests for additional MELD points
is correct

Question 2 Answers
a) MELD points will be automatically awarded after
request to the regional review board (RRB).
b) MELD points may be awarded if a majority of RRB
members approves.
c) MELD points may be awarded by the UNOS
Liver/Intestine Committee.
d) Additional MELD points are not awarded beyond
those clinical conditions approved in the UNOS
allocation policies.
e) MELD points are awarded by the UNOS
Membership and Professional Standards
Committee.

Question 3
Which of the following statements
regarding liver transplant center
survival statistics is correct

Question 3 Answers
a) Transplant center survival statistics do not
take into account severity of illness of
recipients.
b) Transplant center survival statistics are
available upon written request from UNOS.
c) Transplant center survival statistics are
available on line at www.optn.org.
d) Transplant centers may elect not to report
their outcomes to UNOS.
e) Transplant survival statistics are available
only for kidney transplants and not yet for
liver transplants

Question 4
Which of the following statements
regarding UNOS primary liver
transplant physicians is true

Question 4 Answers
a) Physicians receive a certificate from UNOS to
document their qualifications.
b) A UNOS primary liver transplant physician must
have passed the Transplant Hepatology Boards.
c) Transplant centers do not have to have a
primary physician if they have more than one
experienced liver transplant surgeon.
d) Applications to become a center’s primary
transplant physician are reviewed by the UNOS
Membership and Professional Standards
Committee.

What is the OPTN
The Organ Procurement and Transplantation
Network (OPTN) is the unified transplant network
established by the United States Congress under the
National Organ Transplant Act (NOTA) of 1984.
The act called for the network to be operated by a
private, non-profit organization under federal
contract.
The OPTN is a unique public-private partnership that
links all of the professionals involved in the donation
and transplantation system.

OPTN Membership
Under federal law, all U.S. transplant centers and organ
procurement organizations must be members of the
Organ Procurement and Transplantation Network
(OPTN) to receive any funds through Medicare.

OPTN Membership (cont)
Other members of the OPTN include independent
histocompatibility laboratories involved in organ
transplantation; relevant medical, scientific, and
professional organizations; relevant voluntary health and
patient advocacy organizations; and members of the general
public with a particular interest in donation and/or
transplantation.

Who is UNOS
The United Network for Organ Sharing (UNOS), based in
Richmond, Virginia, administers the OPTN under contract
with the Health Resources and Services Administration of
the U.S. Department of Health and Human Services.

UNOS has developed a collaborative policy development,
monitoring, and enforcement process for the OPTN,
and also has systems in place for:
1) Making member inquiries,
2) conducting peer reviews,
3) maintaining data production for reviewing membership
applications, and
4) monitoring member compliance with OPTN policies.

Who Are the UNOS Members
Transplant Centers 260
Independent OPOs 51
Independent Labs 61
Public Members 9
Health Organizations 10
Professional Organizations 28
Consortium Members 3
TOTAL 422

UNOS Committees
• Functional
• Communications
• Donations
• Education
• Ethics
• Finance
• International Relations
• Membership and
Professional Standards
• Constituent
• Histocompatibility
• Minority Affairs
• OPO
• Organ Specific
• Thoracic, Liver,
Kidney/Pancreas
• Patient Affairs
• Pediatrics
• Transplant
Administrators

OPTN/UNOS Liver & Intestine Committee Membership
• Chair and Vice-Chair
• 11 Regional Representatives
• 9 At Large Representatives
• Physicians
• Surgeons
• Anesthesiologist
• OPO Representatives
• Candidate, Recipient, and/or Donor Family Representative
• Transplant Coordinator
• Committee Crossover Members
• 2 HRSA Representative(s)
----------------------------------------------------
Member selection Process
Recommendations by President, Regional Councilors, Fellow Committee Members, OPTN Members, UNOS
Staff, Self, etc. Reviewed by President, Chair and Vice-Chair. Appointed by President.

UNOS Regional Map

What is an OPO
• 3.1.1 OPO. An Organ Procurement
Organization (OPO) is an organization,
accepted as a Member, and authorized by
the Centers for Medicare and Medicaid
Services (CMS) to procure organs for
transplantation. For each OPO, CMS
defines a geographic procurement
territory within which the OPO
concentrates its procurement efforts.

What is a UNOS qualified liver
transplant physician
• Required to operate liver transplant
program (one per program)
• Approved by MPSC
• Qualifications:
• Commitment
• Documented experience through fellowship or
post-graduate exposure
• Currency of knowledge
• GI Fellowship Boarded

Regional Review Boards
Purpose: To provide prompt peer review of
exceptional cases not addressed by the
MELD/PELD allocation system.
Composition: One member from each
transplant program in Region permitted.
Function: Members vote on requests within
72 hours, majority vote rules.
Appeals: Conference call with RRB, Liver
Intestine Committee

How can a Region change organ
allocation policy
• 3.1.8 Variances. The term “Variance” refers
to any system for organ allocation and/or
distribution that meets the criteria for a
“Variance” as described in the Final Rule for
operation of the Organ Procurement and
Transplantation Network, 42 C.F.R. §121.8(g).
Such systems may be designed pursuant to
policy-making processes and the Final Rule,
§121.4, as potentially temporary policies for the
purpose of previewing methods for improving
organ allocation or distribution. They must
include a plan for data collection and analysis
and have a defined time limit for the policy
variation.

Can patients be on more than one list
• 3.2.3 Waiting Time Transferal and Multiple
Listing. Every transplant program must inform
every candidate about the options of multiple
listing, transferring primary waiting time, and the
option to transfer their care to a different
transplant center without loss of accrued waiting
time, during the evaluation process, provide the
candidate with written material on these options,
and maintain documentation that this
requirement was fulfilled

Questions