THE TRANSPLANTATION SOCIETY OF AUSTRALIA AND NEW ZEALAND National Standard Operating Procedures Organ allocation Organ rotations Urgent listings Version 1.0 ATCA-TSANZ SOP 001/2013 a
contents Introduction 1 Purpose 1 Scope 1 Responsibility 1 Part A. General principles 2 1. Organ allocation 2 1.1 Non-renal organ allocation 2 1.2 Kidney allocation 2 2. Urgent listings 3 2.1 Urgent heart listing 3 2.2 Urgent liver listing 4 3. Multi-organ transplants 4 4. Research programs 4 5. Recognised renal transplant units in Australia 5 6. Recognised extra renal transplant units in Australia and New Zealand 5 Part B. Organ allocation procedures 6 1. Heart allocation 6 1.1 Allocation procedures 6 2. Lung allocation 7 2.1 Allocation procedures 7 3. Heart/lung bloc allocation 8 3.1 Allocation procedures 8 4. Liver allocation 9 4.1 Allocation procedures 9 4.2 Paediatric liver allocation rotation 9 4.3 Adult liver allocation rotation 9 5. Intestine/multivisceral allocation 10 5.1 General principles 10 5.2 Allocation procedures 10 6. Pancreas and islets allocation 11 6.1 Allocation procedures 11 6.2 Allocation process for,, ACT, SA, WA and NT 11 6.3 Allocation process for and TAS 11 6.4 Allocation process for New Zealand 11 6.5 General principles 12 7. Kidney allocation 13 7.1 Allocation procedures 13 7.2 Referral procedure 13 Part C. Urgent listing procedures 14 1. Urgent heart listing 14 1.1 Listing a patient on the urgent heart list 14 1.2 Relisting and delisting a patient on the urgent heart list 15 1.3 Review and audit process 15 1.4 Contact details for notification 15 2. Urgent liver listing 16 2.1 Listing a patient on the urgent liver list 16 2.2 Relisting and delisting a patient on the urgent liver list 16 2.3 Review and audit process 17 2.4 Contact details for notification 17 Appendices 18 Appendix 1. Example of use Heart rotation 18 Appendix 2. Example of use Lung rotation 19 Appendix 3. Example of use Lung rotation for heart/lung bloc offers 20 Appendix 4. Example of use Adult liver rotation 21 Appendix 5. Example of template Interstate and New Zealand urgent heart listing 22 Appendix 6. Example of template urgent heart listing 23 Appendix 7. Example of template Interstate and New Zealand urgent liver listing 24 Appendix 8. Example of template urgent liver listing 25 Version Control SOP Reference 001 Version number 1.0 Review date May 2015 Author Francesca Rourke Approved by ATCA Committee and TSANZ Council, endorsed by OTA Date approved May 2013
introduction Introduction The Australasian Transplant Coordinators Association (ATCA) and the Transplantation Society of Australia and New Zealand (TSANZ) have for many years ensured that the distribution and allocation of organs for transplant has been fair and equitable through the development and utilisation of ATCA/TSANZ Organ Allocation Rotation and ATCA Standard Principles and Procedures. This document has been developed based on revision and updating of previous allocation procedures, results of ATCA Extra-Renal Organ Allocation Audit Reports and changes in allocation criteria as per the TSANZ Consensus Statement on Eligibility Criteria and Allocation Protocols Version 1.2. The TSANZ Council and the ATCA Committee have approved this Standard Operating Procedure (SOP) and the Organ and Tissue Authority (OTA) through the Jurisdictional Advisory Group (JAG) have endorsed it. Purpose The purpose of the SOP is to facilitate the distribution and allocation of organs for transplantation in a fair and equitable manner. Scope This document contains operating procedures pertaining to the allocation of organs for transplantation from deceased donors, including use of organ allocation rotations and urgent listing procedures for heart and liver. This document excludes organ allocation from live donors. Responsibility ATCA/TSANZ It is the responsibility of ATCA, supported by the TSANZ Project Officer to audit, review and update the ATCA/TSANZ Organ Allocation Rotations. ATCA will provide the template of each organ rotation to the DonateLife Agencies and New Zealand Donation Service. The template will also be available on the ATCA website and the DonateLife CONNECT site on the DonateLife Network home page. It is recommended a single Master Copy for each rotation is kept to ensure a consistent and accurate process is maintained. DonateLife Agency It is the responsibility of each DonateLife Agency to maintain the ATCA/TSANZ Organ Allocation Rotation documentation that is utilised for their state. Clear and accurate documentation is essential when the rotation is utilised. All changes to the rotations must be included in the handover between the on call state Coordinators to maintain accuracy. 1 1
PART A General principles part a 1. Organ allocation 1.1 Non renal organ allocation a. Organs are offered to the home state first unless there is a patient on an Urgent Listing or the home state does not offer relevant transplant services (ie heart and lung transplant). b. If the home state declines the offer and the organ is deemed medically suitable to offer on, the organ is offered according to the ATCA/ TSANZ Organ Allocation Rotation to ensure a fair and equitable distribution. c. The offer is rotated through each jurisdiction as appropriate, in strict turn until either the organ is accepted or all units have declined the offer. d. If ALL transplant units decline the offer, it is then rotated through units with Non- Nationals (citizens of other countries) awaiting transplantation. e. Transplanting units must respond to an offer of an organ within 30 minutes of receiving the offer. f. Units receiving offers should make every effort to respond as quickly as possible to expedite the allocation process. 1.2 Kidney allocation a. The allocation of kidneys is coordinated through the National Organ Matching System (NOMS). The major criteria used by NOMS in allocation are blood group, HLA match, donor and recipient antibodies, and waiting time. b. Donation after Cardiac Death (DCD) Kidney: Transplanting units will have 60 minutes to accept or decline a DCD kidney offer. c. Donation after Brain Death (DBD) Kidney: Transplanting units will have 60 minutes to accept or decline a DBD kidney offer. d. Units receiving offers should make every effort to respond as quickly as possible to expedite the allocation process. 2
2. Urgent listings Urgent listings exist for liver and hearts and can be used for patients who have a very high risk of death if they are not transplanted in the near future. Patients on the urgent listing are offered the next compatible organ arising anywhere in Australia and New Zealand. The following information regarding criteria for urgent listing is taken from the TSANZ Eligibility Criteria and Allocation Protocols Consensus Statement Version 1.2. 2.1 Urgent heart listing a. When a patient s survival is estimated to be days or weeks without transplantation, the patient may be placed on the urgent list in which case the next compatible donor heart arising anywhere in Australia or New Zealand will be offered for that individual. e. In the event that there are simultaneously listed urgent patients, the following process will be followed: I. When there is more than one patient on the urgent heart listing, the compatible donor heart will be offered to the patient who was listed first, however II. If a compatible donor becomes available in the same state as the urgently listed patient the heart will be offered first to the home state Transplant Unit, regardless of the order of listing. For example: There are two patients on the urgent heart listing, one from the other from. The patient from was listed first and the Victorian patient was listed two days later. home state transplant unit. If declined by home state, the heart will go back on offer using the ATCA/TSANZ Heart Allocation Rotation. b. Urgent listing is at the discretion of the Transplant Unit Director. It is the responsibility of that unit to notify all other Cardiothoracic Transplant Units and the DonateLife Agencies in Australia and the New Zealand Donation Agency and Transplant Unit, when a patient is listed or delisted from the urgent list. c. A patient placed on the urgent listing will remain active for two weeks. In the event that a person remains urgently listed beyond 2 weeks, re-notification of all Cardiothoracic Transplant Units and the DonateLife Agencies is required fortnightly. d. An acceptance of a heart offer for an urgent patient should not be part of the normal rotation or documented as a rotational offer. Scenario 1 has a donor. The heart will be offered first to the patient. If declines the offer, the heart will be offered to the Victorian patient. If declined then the heart will be offered to the home state transplant unit. If declined by home state, the heart will go back on offer using the ATCA/TSANZ Heart Allocation Rotation. Scenario 2 has a donor. The heart would be offered first to the Victorian home state transplant unit for their urgent patient. If declined by, then the heart will be offered to the patient. If declined then the heart will be offered to the Victorian 3
2.2 Urgent liver listing a. Any liver becoming available within Australia or New Zealand is first to be allocated to patients listed as urgent. b. An acceptance of a liver offer for an urgent patient should not be part of the normal rotation or documented as a rotational offer. c. It is the responsibility of the Liver Transplant Unit who wishes to list a patient urgently to notify all other Liver Transplant Units and the DonateLife Agencies in Australia and the New Zealand Donation Agency and Transplant Unit, when a patient is listed or delisted from the urgent list. d. There are three separate categories of patients for urgent liver transplantation. Category 1 1. Patients with acute liver failure that are ventilated and in an intensive care unit. 2. Allocation is mandatory. 3. Relisting every 72 hours is required. Category 2a 1. Patients with acute liver failure that are not yet ventilated but nevertheless meet Kings College Criteria or paediatric patients with severe acute or chronic liver disease who are very unwell in an intensive care unit. 2. Allocation is usual but not mandatory. It is subject to discussion between directors (or delegates) of donor and recipient state/nz transplant units. 3. Relisting every 72 hours is required. Category 2b 1. Paediatric patients with severe metabolic disorders or hepatoblastoma for whom a limited time period exists during which liver transplantation is possible. 2. Relisted on a weekly basis. 3. Multi-organ transplants a. Combined transplants eg. liver/kidney, heart/ kidney, need to be formally approved by local transplant committees and formal notification provided to the relevant interstate committees and DonateLife Agencies. b. Organs should not be allocated to recipients for combined transplants prior to completion of this formalised process. The only exception to this is heart/lung bloc offers and kidney/ pancreas offers (TSANZ Consensus Statement on Eligibility Criteria and Allocation Protocols Version 1.2). 4. Research programs a. Research is an internal process specific to each DonateLife Agency. b. All specificities related to the offer of an organ with respect for research, must be communicated to the accepting transplant unit, Coordinator and retrieval teams. 4
5. Recognised renal transplant units in Australia SA WA Renal transplant units Princess Alexandra Hospital Adults Mater Children s Hospital Paediatric The Children s Hospital at Westmead East Coast Renal Transplant Service Prince of Wales Hospital and Sydney Children s Hospital John Hunter Hospital Royal North Shore Hospital Statewide Renal Services Royal Prince Alfred Hospital Westmead Hospital The Alfred Hospital Austin Hospital Monash Medical Centre Royal Children s Hospital The Royal Melbourne Hospital St Vincent s Hospital Royal Adelaide Hospital Women s and Children s Hospital Princess Margaret Hospital for Children Royal Perth Hospital Sir Charles Gairdner Hospital 6. Recognised extra renal transplant units in Australia and New Zealand Heart transplant units WA NZ Prince Charles Hospital St Vincent s Hospital Alfred Hospital Adults Royal Children s Hospital Paediatric Royal Perth Hospital Auckland Public Hospital Lung transplant units WA NZ Prince Charles Hospital St Vincent s Hospital Alfred Hospital Adults and Paediatric Royal Perth Hospital Auckland Public Hospital Adult liver transplant units SA WA NZ Princess Alexandra Hospital Royal Prince Alfred Hospital Austin Hospital Flinders Medical Centre Charles Gairdner Hospital Auckland City Hospital Paediatric liver transplant units NZ Royal Children s Hospital Children s Hospital at Westmead Royal Children s Hospital Starship Children s Hospital Pancreas transplant units NZ Australian National Pancreas Transplant Unit Westmead Hospital Australian National Pancreas Transplant Unit Monash Medical Centre New Zealand National Pancreas Transplant Unit Auckland Hospital 5
part b Part B Organ allocation procedures 1. Heart allocation 1.1 Allocation procedures a. The heart is offered to the home state first, unless there is an urgent listing. b. When there is a patient on the urgent listing, the urgent listing allocation procedures are to be followed. c. The ATCA/TSANZ Heart Allocation Rotation is bypassed when a heart is offered for a patient on the urgent listing. Acceptance or decline of an offer is not recorded on the rotation. In the event the heart is not accepted for any urgent listed patients the heart is offered back to the home state. d. If the home state declines the offer then the ATCA/TSANZ Heart Allocation Rotation is utilised and offers are made in strict rotational order. e. Victoria has two heart transplant units: I. The Royal Children s Hospital: The National Centre for Paediatric Heart Transplantation II. The Alfred Hospital: The state Adult Heart Transplant Unit f. When a heart is offered to Victoria both transplant units must receive the offer before moving to the next state on rotation. The rotation between the Paediatric and Adult units in Victoria is documented on the ATCA/ TSANZ Heart Allocation Rotation kept by each DonateLife Agency. An example of use and documentation of this process is provided in the appendices. (See Appendix 1) g. The ATCA/TSANZ Heart Allocation Rotation is utilised for all heart offers originating from South Australia and the Northern Territory as there is no home state transplant unit. h. New Zealand is not included in the ATCA/ TSANZ Heart Allocation Rotation. However, in the event that the heart is declined by all Australian heart transplant units, the offer may be made to New Zealand. Please note: this is not a TSANZ mandatory requirement. If this offer is made it is recorded in the DonateLife Electronic Donor Record, not on the Heart Allocation Rotation. i. New Zealand heart offers that are declined by the New Zealand Heart Transplant Unit may be offered by New Zealand to recognised heart transplant units in Australia. 6
j. It is the responsibility of the State Donation Specialist Coordinator to contact the appropriate person in each state and provide the heart offer referral. Listed in the table are the contact details for each state and New Zealand. State Contact for heart offers WA NZ via the PA Hospital switch board Heart/Lung Transplant Coordinator via On-Call mobile Royal Children s Hospital: Heart Transplant Coordinator On-Call via RCH switch board The Alfred: Heart/Lung Transplant Coordinator On-Call via the hospital switch board Heart Transplant via Royal Perth Hospital switch board Heart/Lung Transplant via Auckland City Hospital switch board Numbers 07 3176 2111 0416 143 723 03 9345 5522 03 9076 2000 08 9483 6999 Pager: 60 61 01 0011 6493074949 2. Lung allocation 2.1 Allocation procedures a. The lungs are offered to the home state first. b. If the home state declines the offer then the ATCA/TSANZ Lung Allocation Rotation is utilised and offers are made in strict rotational order. c. In Victoria there is a single Lung Transplant Unit for both adult and paediatric patients, based at the Alfred Hospital. All lung offers to Victoria are made to the Alfred Hospital. An example of use and documentation of this process is provided in the appendices. (See Appendix 2). d. Donation after Cardiac Death (DCD) donor lungs are to be offered on the standard ATCA/ TSANZ Lung Allocation Rotation. e. It is the responsibility of the State Donation Specialist Coordinator to contact the appropriate person in each state and provide the lung offer referral. Listed in the table are the contact details for each state and New Zealand. State Contact for lung offers Numbers WA NZ via the PA Hospital switch board Heart/Lung Transplant Coordinator via On-Call mobile Heart/Lung Transplant via the Alfred Hospital switch board Lung Transplant via Royal Perth Hospital switch board Heart/Lung Transplant via Auckland City Hospital switch board 07 3176 2111 0416 143 723 03 9076 2000 08 9483 6999 Pager: 60 40 07 0011 6493074949 7
3. Heart/lung bloc allocation 3.1 Allocation procedures a. In the event the home state declines BOTH the donor heart and lungs the heart/lung bloc is offered using the ATCA/TSANZ Lung Allocation Rotation. b. The first state on the Lung Allocation Rotation has the following options: I. Accept the heart/lung bloc for a single recipient II. Accept the heart and lungs for two separate recipients III. Accept one of the organs and decline the other IV. Decline both organs. c. When the first state on rotation accepts only one of the thoracic organs the remaining organ is offered as per that organs allocation rotation. For example: I. Lungs are accepted: heart is offered to the next state on the Heart Allocation Rotation II. Heart is accepted: lungs are offered to the next state on the Lung Allocation Rotation. d. When offering a heart/lung bloc to Victoria both the paediatric and adult transplant units must be contacted before moving on to the next state on rotation. This is to remove any disadvantage to the RCH and to ensure the unit receives the opportunity to accept the heart only from the bloc. For example: e. Victoria is first state on the lung rotation with the paediatric unit at RCH to receive first offer of the bloc. The paediatric unit accepts the heart from the bloc offer. The lungs are then offered to the adult unit at the Alfred before offering to the next state on rotation. f. However, when Victoria is first state on the lung rotation with the adult unit to receive first offer and they accept the heart and decline the lungs, the paediatric unit would not be offered the lungs (see Lung Allocation Procedures page 8). In this scenario the lungs would be offered to the next state on rotation and the paediatric unit would be bypassed. An example of use and documentation of this process is provided in the appendices. (See Appendix 3). g. It is the responsibility of the State Donation Specialist Coordinator to contact the appropriate person in each state and provide the heart/lung bloc offer referral. Listed in the table are the contact details for each state and New Zealand. State WA NZ Contact for heart/lung bloc offers via the PA Hospital switch board Heart/Lung Transplant Coordinator via On-Call mobile Royal Children s Hospital: Heart Transplant Coordinator On-Call via RCH switch board The Alfred: Heart/Lung Transplant Coordinator On-Call via the hospital switch board Lung Transplant via Royal Perth Hospital switch board Heart/Lung Transplant via Auckland City Hospital switch board Numbers 07 3176 2111 0416 143 723 03 9345 5522 03 9076 2000 08 9483 6999 Pager: 60 40 07 0011 6493074949 8
4. Liver allocation 4.1 Allocation procedures a. The liver is offered to home state first, unless there is an urgent listing. b. When there is a patient on the urgent listing, the urgent listing allocation procedures are to be followed. c. The ATCA/TSANZ Liver Allocation Rotation is bypassed when a liver is offered for an urgent listed patient. Acceptance or decline of an offer made to an urgent listing is not recorded on the rotation. d. When there is a Category 1 urgent listing, the home state will be informed of the donor liver but it is mandatory the liver is offered first to the urgent listed patient. If the offer is declined for the urgent listed patient, the liver is offered back to the home state. e. When there is a Category 2 urgent listing, allocation to the urgent listed patient is usual but not mandatory. It is subject to discussions between the liver transplant centres of the donor and recipient state/nz. If the offer is declined for the urgent listed patient, the liver is offered back to the home state. f. If the home state declines the offer then the appropriate ATCA/TSANZ Liver Allocation Rotation is utilised and offers are made in strict rotational order. g. There are two ATCA/TSANZ Liver Allocation Rotations: Paediatric and Adult. 4.2 Paediatric liver allocation rotation a. It is the policy of the TSANZ Liver Advisory Committee that every effort is made to transplant paediatric donor livers into paediatric recipients. b. A paediatric donor liver is defined as donors 18 years of age. c. The currently recognised Paediatric Liver Transplant Units are located in Queensland,, Victoria and New Zealand. d. When the home state is unable to allocate a paediatric donor liver to a paediatric recipient the WHOLE liver will be offered on the ATCA/ TSANZ Paediatric Liver Allocation Rotation. e. In the event the liver cannot be allocated to a paediatric recipient within Australia and New Zealand, the home state can allocate to an adult recipient. 4.3 Adult liver allocation rotation a. An adult donor liver is defined as donors > 18 years of age. b. When the home state is unable to accept an adult donor liver the WHOLE liver will be offered on the ATCA/TSANZ Adult Liver Allocation Rotation. c. The decision to split the liver is made by the home state Liver Transplant Unit. In the event the home state decides to split the liver but can only transplant one recipient, the remaining right or left segment will be offered on the appropriate liver rotation. I. Right segment to be allocated interstate: offer on Adult Liver Allocation Rotation II. Left segment to be allocated interstate: offer on Paediatric Liver Allocation Rotation d. The WA and SA Liver Transplant Units have an agreement that when a liver is not accepted in either home state the liver will be offered first to each other PRIOR to offering the liver on the ATCA/TSANZ Liver Allocation Rotation. This has been supported by TSANZ. As a result, for the purpose of the adult liver rotation, WA and SA are treated as two units from one state. Each state alternates first and second offer. The allocation process in this situation is identical to the heart offers to the two Victorian Transplant Units. An example of use and documentation of this process is provided in the appendices. (See Appendix 4). 9
e. It is the responsibility of the State Donation Specialist Coordinator to contact the appropriate person in each state and provide the liver offer referral. Listed in the table are the contact details for each state and New Zealand. State Contact for liver offers Numbers WA SA NZ via the PA Hospital switch board Liver Transplant Coordinator via RPA Hospital switch board Liver Transplant Coordinator via Austin Hospital switch board via Sir Charles Gairdner Hospital switch board Liver Transplant Coordinator via Flinders Medical Centre switch board 07 3176 2111 02 9515 6111 03 9496 5000 08 9346 3333 08 8204 5511 0011 6496 300935 5. Intestine/multivisceral allocation 5.1 General principles a. There is a single Intestinal/Multivisceral Transplant unit in Australia located at The Austin Hospital in Victoria. b. The Intestinal Transplant Service treats both adult and paediatric patients from all over Australia. Patients may be listed for isolated small intestine or multivisceral transplantation, which may be a combination of small bowel, pancreas, stomach, duodenum, liver and kidneys. c. A national waiting list is provided to all Liver Transplant Units in Australia and New Zealand. d. There is no ATCA/TSANZ Intestinal/ Multivisceral Allocation Rotation. 5.2 Allocation procedures a. The procedure to offer donor intestine to the Intestinal/Multivisceral Transplant unit begins with a clinical decision by the donor home state Liver Transplant Unit and involves the following steps. b. A donor liver is offered as per standard procedure. c. The Liver Transplant unit will then assess if the donor would be a suitable intestinal donor and if a formal offer/referral should be made to the Intestinal/Multivisceral Transplant unit. The decision to waiver the original liver offer would be discretionary and involve discussion between clinicians of each transplant unit. d. If it is deemed appropriate by the home state Liver Transplant unit the donor intestine will formally be offered to the Intestinal/ Multivisceral Transplant unit for consideration. State Contact for intestinal/ multivisceral offers Liver Transplant Coordinator via Austin Hospital switch board Numbers 03 9496 5000 10
6. Pancreas and islets allocation 6.1 Allocation procedures a. There are two Pancreas Transplant units in Australia; the Westmead National Pancreas Transplant Unit in Sydney and Monash Medical Centre in Victoria. b. There are two islet processing laboratories in Australia; Westmead Hospital and St Vincent s Hospital Melbourne. c. There is no ATCA/TSANZ Pancreas and Islet Allocation Rotation. 6.2 Allocation process for,, ACT, SA, WA and NT Donor pancreas organs arising in these states and territories are allocated in the following way: a. Whole pancreas offered to the Westmead National Pancreas Transplant Unit for consideration of simultaneous kidney and pancreas transplantation. b. If pancreas is deemed medically suitable for transplantation but Westmead decline the offer due to no suitable recipient or logistical reasons, then the whole pancreas is offered to the Monash Medical Centre in Victoria. c. I f Monash decline the offer then the pancreas is offered back to Westmead for islet transplantation. d. If Westmead decline for islet transplantation then the Victorian Islet Program will receive the offer. e. If both centres decline the pancreas for transplantation (whole and islet) it may be used for research if appropriate consent obtained. 6.3 Allocation process for and TAS Donor pancreas organs arising in these states are allocated in the following way: a. Whole pancreas offered to the Monash Medical Centre in Victoria for consideration of simultaneous kidney and pancreas transplantation. b. If pancreas is deemed medically suitable for transplantation but Monash decline the offer due to no suitable recipient or logistical reasons, then the whole pancreas is offered to the Westmead National Pancreas Transplant Unit. c. If Westmead decline the offer then the pancreas is offered back to the Monash Medical Centre for islet transplantation. d. If Monash decline for islet transplantation then the Westmead Islet Program will receive the offer. e. If both centres decline the pancreas for transplantation (whole and islet) it may be used for research if appropriate consent obtained. 6.4 Allocation process for New Zealand a. Donor pancreas organs arising in New Zealand are initially offered to the Auckland National Pancreas Transplant Unit. If the Auckland Unit is unable to use the pancreas then the Australian National Pancreas Transplant Units (Westmead and Monash) will receive the offer. 11
6.5 General principles a. For combined pancreas/kidney transplants, the LEFT kidney is always preferred. b. Offers of pancreas for islets are only made when the whole organ has been declined for transplantation. c. When a suitable pancreas is donated for a simultaneous pancreas and kidney transplant, one of the donor kidneys is allocated for the recipient of the pancreas. This leaves one donor kidney available to be allocated according to the National Organ Matching System (NOMS) computer program to a kidney alone recipient. d. However, if there is a second kidney alone recipient who has a very good match at Level 1, 2 or 3 on NOMS, the allocation to the simultaneous pancreas and kidney patient will be overridden and the second kidney will be allocated to the kidney alone patient identified on NOMS. e. It is the responsibility of the State Donation Specialist Coordinator to contact the appropriate person in each state and provide the pancreas/islets offer referral. Listed in the table are the contact details for each state. State Contact for pancreas/islets offers Pancreas and islet offer: Pancreas Transplant Coordinator via Westmead Hospital Switch Board Pancreas offer: Switch Board at Monash Medical Centre and request to speak to: 1st Contact: Nephrologist On-Call 2nd Contact: A/Professor John Kanellis 3rd Contact: Dr Bill Mulley Islet offer: Tom Loudovaris Islet Transplant Coordinator via On-Call mobile Numbers 02 9845 5555 03 9594 6666 0418 382 987 12
7. Kidney allocation 7.1 Allocation procedures a. The allocation of kidneys from brain death (DBD) and cardiac death (DCD) donation is coordinated through the National Organ Matching System (NOMS). The major criteria used by NOMS in allocation are blood group, HLA match, donor and recipient antibodies, and waiting time. The system also maintains an approximate balance in donor kidneys between the states. b. Donated kidneys go through a two-level allocation process coordinated through NOMS. c. The National Kidney Interstate Exchange program primarily tries to find suitable kidneys for patients who have a very high level of human leukocyte antigen (HLA) antibodies and only 0, 1 or 2 HLA mismatches with the donor. It will also allocate kidneys to patients who have perfect HLA matching with the donor. d. State based allocation: The majority of kidneys are allocated within the home state. e. When NOMS identifies a patient through the National Kidney Exchange as either a difficult to match patient or a perfect HLA match to the donor kidney, the home state must offer the kidney to that specific patient regardless of their location within Australia. f. New Zealand does not participate in the National Kidney Interstate Exchange program. g. A Hepatitis C Positive register exists to allow transparent and equitable allocation of kidneys from HCV positive donors to HCV positive recipients. 7.2 Referral procedure a. When a kidney needs to be offered to an interstate recipient it is the responsibility of the State Coordinator to contact the appropriate person in the recipient state and provide the kidney offer referral. b. The Coordinator from the donor state should make all reasonable attempts to refer the kidney prior to or during the donor retrieval surgery to minimise ischaemic times when kidneys are allocated interstate. c. Due to use of Luminex screening and the complexity of the tissue typing results, it is a recommendation of the Renal Transplant Advisory Committee (RTAC) that the recipient NOMS tissue typing is either faxed or emailed at the time of referral to provide a hard copy for review and assessment by the renal physician. d. Transplant Unit Surgical request for left or right kidney allocation for a recipient is acceptable practice and must be honoured at time of allocation. This is a directive from RTAC. e. DCD Kidney: Transplanting units will have 60 minutes to accept or decline a DCD kidney offer. If 60 minutes has passed without a response the kidney offer will go to the next recipient on the NOMS list. f. DBD Kidney: Transplanting units will have 60 minutes to accept or decline a DBD kidney offer. If 60 minutes has passed without a response the kidney offer will go to the next recipient on the NOMS list. g. Listed in the table are the contact details for each state. State WA SA Contact for kidney offers Numbers 07 3176 2111 02 9963 2801 03 9347 0408 08 9346 3333 08 8378 1671 13
part c PART C Urgent listing procedures 1. Urgent heart listing 1.1 Listing a patient on the urgent heart list a. Once a patient has been assessed as meeting urgent status for heart transplantation by the Transplant Unit Director they (or his or her nominee) are responsible for notifying all other Cardiothoracic Transplant Unit Directors (or his or her nominee) in Australia and New Zealand. b. The Transplant Unit Director is responsible for notifying the Recipient Coordinator in their state of the details of the patient who is to be placed on the Urgent List. c. It is the responsibility of the Recipient Coordinator to then ensure the appropriate donor and recipient coordinators in Australia and New Zealand are notified of the urgent listing. d. It is recommended that notification is by direct telephone conversations and not sent via email. This practice is to ensure that notification is confirmed at the time of listing and to avoid the potential of a missed heart offer in the event a donation is occurring at the time of listing. e. The ATCA/TSANZ Urgent Heart Listing templates are to be utilised for documenting and recording of the notification process. There are two templates to be utilised. An example of use and documentation of this process is provided in the appendices. (See Appendix 5 and 6). I. The Interstate and New Zealand Urgent Heart Listing template is for the Transplant Units and DonateLife Agencies to record details of interstate and New Zealand urgent heart listings. II. The state specific template eg: Urgent Heart Listing is for each state and New Zealand that has a Cardiothoracic Transplant Unit to record their notification process when listing a patient on the Urgent Heart List. f. BOTH the donor and recipient coordinators in each state and New Zealand must be notified of the urgent listing. There is space on the templates to record the name of both coordinators who have received the listing details. The exception is in SA and the NT, where only the Coordinator is notified. 14
1.2 Relisting and delisting a patient on the urgent heart list a. It is the responsibility of the Recipient Coordinator to notify the appropriate donor and recipient coordinators in Australia and New Zealand when a patient is to be relisted or delisted from the Urgent Heart List. b. A patient placed on the urgent heart listing will remain active for two weeks. In the event that a person remains urgently listed beyond 2 weeks, re-notification of all Cardiothoracic Transplant Units and the DonateLife Agencies is required fortnightly. c. In the event a patient is to be delisted the notification process needs to occur as soon as possible. d. The ATCA/TSANZ Urgent Heart Listing templates are to be utilised for documenting and recording of the notification process when a patient is relisted or delisted. 1.3 Review and audit process a. The operation of the urgent listing will be subject to annual audit and review by the TSANZ Cardiac Advisory Committee. b. The Cardiothoracic Transplant Units in Australia and New Zealand and the DonateLife Agencies are responsible for accurate documentation and record keeping. All ATCA/ TSANZ Urgent Heart Listing documents that have been utilised must be kept and will facilitate the annual audit and review by TSANZ. 1.4 Contact details for notification State WA NZ Recipient coordinator contacts Heart/Lung Transplant via the Prince Charles Hospital switch board Heart/Lung Transplant via mobile Royal Children s Hospital: Heart Transplant Coordinator On-Call via RCH switch board The Alfred: Heart/Lung Transplant Coordinator On-Call via the Hospital switch board Heart Transplant via Royal Perth Hospital switch board Heart/Lung Transplant via Auckland City Hospital switch board Numbers 07 3139 4000 0416 143 723 03 9345 5522 03 9076 2000 08 9483 6999 Pager: 60 61 01 0011 64 9307 4949 State WA SA NT NZ Donation specialist coordinator contacts Numbers 07 3176 2111 02 9963 2801 03 9347 0408 08 9346 3333 08 8378 1671 08 8922 8888 0011 64 9630 0935 15
2. Urgent liver listing 2.1 Listing a patient on the urgent liver list a. Once a patient has been assessed as meeting urgent status for liver transplantation by the Transplant Unit Director they (or his or her nominee) are responsible for notifying the Recipient Coordinator in their state of the details of the patient who is to be placed on the Urgent List. b. It is the responsibility of the Recipient Coordinator to then ensure the appropriate donor and recipient coordinators in Australia and New Zealand are notified of the urgent listing. (In Queensland and Western Australia the person responsible for notification will be the Coordinator). c. It is recommended that notification is by direct telephone conversations and not sent via email. This practice is to ensure that notification is confirmed at the time of listing and to avoid the potential of a missed liver offer in the event a donation is occurring at the time of listing. d. When a Category 2a patient is being listed an Australian and New Zealand Liver Transplant Registry (ANZLTR) Urgent Listing Data Form must be completed by the Liver Transplant Unit and provided to the ANZLTR Manager at the time of notification. When notification occurs outside of business hours it is acceptable to provide the ANZLTR Urgent Listing Data Form the next working day. The form may be emailed or faxed. This form is not required for Category 1 or 2b patients. e. The ATCA/TSANZ Urgent Liver Listing templates are to be utilised for documenting and recording of the notification process. There are two templates to be utilised. An example of use and documentation of this process is provided in the appendices (see Appendix 7and 8). I. The Interstate and New Zealand Urgent Liver Listing template is for the Transplant Units and DonateLife Agencies to record details of interstate and New Zealand urgent liver listings. II. The state specific template eg: Urgent Liver Listing is for each state and New Zealand that has a liver Transplant Unit to record the notification process when listing a patient on the Urgent Liver List. f. BOTH the donor and recipient coordinators in each state and New Zealand must be notified of the urgent listing. There is space on the templates to record the name of both coordinators who have received the listing details. The exception is in, WA and the NT, where only the State Coordinator is notified. 2.2 Relisting and delisting a patient on the urgent liver list a. It is the responsibility of the Recipient Coordinator to notify the appropriate donor and recipient coordinators in Australia and New Zealand when a patient is to be either relisted or delisted from the Urgent Liver List. (In and WA the person responsible for notification will be the State Donation Specialist Coordinator.) b. In the event a patient is to be relisted the notification process must occur at the required time frames. I. Category 1 and 2a every 72 hours II. Category 2b weekly c. When relisting a Category 2a patient an updated ANZLTR Urgent Listing Data form must be provided to the ANZLTR Manager at the time of notification. d. A patient may be delisted as a result of receiving a transplant, improving, no longer fit for transplant or death occurring. e. In the event a patient is to be delisted the notification process needs to occur as soon as possible to avoid unnecessary liver offers being made. f. The ATCA/TSANZ Urgent Liver Listing templates are to be utilised for documenting and recording of the notification process when a patient is relisted or delisted. 16
2.3 Review and audit process 2.4 Contact details for notification a. The operation of the urgent liver waiting list will be subject to annual audit and review by the TSANZ Liver Advisory Committee. b. The Liver Transplant Units in Australia and New Zealand and the DonateLife Agencies are responsible for accurate documentation and record keeping. All ATCA/TSANZ Urgent Liver Listing documents that have been utilised must be kept and will facilitate the annual audit and review by TSANZ. State SA Recipient coordinator contacts Liver Transplant Coordinator via RPA Hospital switch board Liver Transplant Coordinator via Austin Hospital switch board Liver Transplant Coordinator via Flinders Medical Centre switch board Numbers 02 9515 6111 03 9496 5000 08 8204 5511 NZ Liver Transplant 0011 64 9307 4949 State Donation specialist coordinator contacts Numbers WA SA NT NZ 07 3176 2111 02 9963 2801 03 9347 0408 08 9346 3333 08 8378 1671 08 8922 8888 0011 64 9630 0935 17
appendix Appendix 1 Example of use heart rotation HEART rotation Date Time Donor number Donor hospital ABO AGE HT WT 08/10/12 1930 N1200 Westmead A+ 17 159 52 Mary Smith 08/10/12 1950 N1200 Westmead A+ 17 159 52 Mary Smith 12/10/12 2300 N1215 Royal North Shore O+ 45 185 95 Jill Able 12/10/12 2330 N1215 Royal North Shore O+ 45 185 95 Jill Able 20/11/12 1600 1655 N1220 RPA AB- 25 159 62 Kelly Skye 20/11/12 1755 N1220 RPA AB- 25 159 62 Kelly Skye Donor Coordinator Explanation of rotation entries 1. Donor N1200: declined by then offered to. Paediatric unit will receive heart offer first and they accept the heart. Heart allocated end of rotation. Next state to receive an offer on rotation will be WA. 2. Donor N1215: offered to WA who decline. Offered to who accept. Heart allocated end of rotation. Next state to receive an offer on rotation will be. 3. Donor N1220: The Adult unit will receive heart offer first which they decline. Offered next to Paediatric unit who also decline. Both units must receive the offer before moving on to the next state on rotation. Offered to WA as next state on rotation who accept. Heart allocated end of rotation. Recipient Coordinator Rotation Code Comments Tracey Wills Lisa Black Anne Yellow Sam Trebble Kylie Blue Lisa Black Anne Yellow 2 No ABO match (P) 1 (A) WA 2 No size/abo match 1 (A) 2 No group/size match (P) 2 Donor too big WA 1 (P) (A) WA ATCA-TSANZ SOP 001/2013 Version 1.0 Heart Rotation CODES 1. Accepted 2. No suitable Recipient (NSR) 3. Logistics (please expand) 4. Not medically suitable (NMS) 5. Time > 30 minutes a 18
Appendix 2 Example of use lung rotation LUNG rotation Explanation of rotation entries 1. Donor N1233: offered to and accepted by. Lungs allocated end of rotation. Next state to receive an offer on rotation will be. 2. Donor N1240: offered to. All lung offers are made to the Victorian Adult Unit at the Alfred. This is why the (P) box in the Lungs column has No offer required. declines the lungs. The lungs are then offered to as the next state on rotation who accept the offer. Lungs allocated end of rotation. Date Time Donor number Donor hospital ABO AGE HT WT Donor Coordinator 05/01/12 1930 N1233 Westmead AB 35 164 65 Tracey White Recipient Coordinator Rotation Code Comments Mary Leate Lungs 1 Heart lung bloc 15/01/12 2300 N1240 St George A 16 152 55 Lisa Black 15/01/12 2345 N1240 St George A 16 152 55 Lisa Black Bill Wall Amy Blue (A) 2 No size match (P) No offer required 1 CODES 1. Accepted 2. No suitable Recipient (NSR) 3. Logistics (please expand) 4. Not medically suitable (NMS) 5. Time > 30 minutes (P) (A) (A) (P) No offer required No offer required ATCA-TSANZ SOP 001/2013 Version 1.0 Lung Rotation 19
Appendix 3 Example of use lung rotation for heart/ lung bloc offers LUNG rotation Explanation of rotation entries 1. Donor N1240: heart/lung bloc offered to. Lungs accepted and heart declined by. Heart is then offered to the next state on the HEART rotation form. 2. Donor N1241: offered to. Adults are first offer of the bloc they accept the heart and decline the lungs. The Victorian Paediatric Unit does not receive the lung offer as all lungs get offered to the Victorian Adults Unit. The lungs are offered to the next state on the rotation. is offered and accepts the lungs. 3. Donor N1250: is first to receive the Bloc offer the Victorian Paediatric Unit ( (P)) is first to receive the bloc offer. They accept the heart and decline the lungs. Lungs are then offered to Adults Unit ( (A)) who decline. is the next state on rotation to receive the offer of lungs, which they decline. This is the end of the allocation. Date Time Donor number Donor hospital ABO AGE HT WT 03/01/12 1930 N1240 RPA AB 35 164 65 Mary Smith 08/01/12 2300 N1241 Westmead A 17 182 78 Sue Read 08/01/12 2300 N1241 Westmead A 17 182 78 Sue Read 13/01/12 1600 N1250 Lismore B 42 152 48 Mary Smith 13/01/12 1700 N1250 Lismore B 42 152 48 Mary Smith Donor Coordinator Recipient Coordinator Rotation Code Comments Tracey White Lisa Black Tim Stone Amy Wills Lisa Black Tracey White Lungs Heart lung bloc 1 (A) 1 (P) No offer required Lungs accepted Heart declined Heart accepted Lungs declined 1 Lungs accepted (P) No offer required (A) 2 CODES 1. Accepted 2. No suitable Recipient (NSR) 3. Logistics (please expand) 4. Not medically suitable (NMS) 5. Time > 30 minutes 1 Heart accepted Lungs declined Lungs declined No match size 2&4 Lungs declined ATCA-TSANZ SOP 001/2013 Version 1.0 Lung Rotation 20
Appendix 4 Example of use adult liver rotation Explanation of rotation entries 1. Donor N1245: Liver is offered to who decline. also decline. The combined SA/ WA is next on rotation with SA to receive first offer. SA declines the liver offer. The offer will then go to the WA unit who accept the liver. Liver allocated end of rotation. 2. Donor N1251: Liver is offered in order to NZ, and and is declined by all three units. The combined SA WA transplant units are next on rotation with WA to receive the first offer. WA is offered and accepts the liver. Liver allocated end of rotation. 3. Donor N1266: The next time the rotation is utilised the first unit to receive the offer is NZ. Please note that SA does not receive the offer in this situation. adult LIVER rotation Donor >18 years of age Date Time Donor number Donor hospital ABO AGE HT WT Donor Coordinator Recipient Coordinator Rotation Code Comments 06/02/12 1830 N1245 Westmead A 39 164 65 Mary Smith Tracey White 3 Already transplanting, no team available 06/02/12 1850 N1245 Westmead A 39 164 65 Mary Smith Anne Yellow 3 No surgeons available, 3 local donors Kelly Green SA 2 No size match 06/02/12 1940 N1245 Westmead A 39 164 65 Mary Smith Adam Gold WA 1 01/03/12 2200 N1251 John Hunter AB 55 185 95 Polly Lime Sally Ball NZ 2 No AB patient on list 01/03/12 2215 N1251 John Hunter AB 55 185 95 Polly Lime Tracey White 2 No AB patient on list 01/03/12 2230 N1251 John Hunter AB 55 185 95 Polly Lime Anne Yellow 2 Size and ABO mismatch Adam Gold WA 1 01/03/12 2300 N1251 John Hunter AB 55 185 95 Polly Lime SA 05/05/12 2050 N1266 RPA O 25 162 65 Mary Smith Sally Ball NZ 1 CODES 1. Accepted 2. No suitable Recipient (NSR) 3. Logistics (please expand) 4. Not medically suitable (NMS) 5. Time > 30 minutes ATCA-TSANZ SOP 001/2013 Version 1.0 Adult Liver Rotation 21
Appendix 5 Example of template Interstate and New Zealand urgent heart listing 22
Appendix 6 xample of template E urgent heart listing 23
Appendix 7 Example of template Interstate and New Zealand urgent liver listing 24
Appendix 8 Example of template urgent liver listing 25