Embracing the Magic: Increasing Organ Acceptance Rates Through Data Review and Risk Stratification

Transcription

1 Embracing the Magic: Increasing Organ Acceptance Rates Through Data Review and Risk Stratification Presented by: Sandy Felty, RN, MSN, MHA Lynette Martin del Campo, RN, MSN, FNP-C Sharon Norfles, RN, BSN

2 Overview- Kidney Scarcity There are currently 121,678 people waiting for lifesaving organ transplants in the U.S. Of these, 100,791 await kidney transplants. (as of 1/11/16)¹ In 2014, 4,761 patients died while waiting for a kidney transplant. Another, 3,668 people became too sick to receive a kidney transplant On average, 13 people die each day while waiting for a life-saving kidney transplant Despite the high demand for donated kidneys, many of the kidneys procured end up being discarded rather than transplanted. In many instances, the organ could have been successfully transplanted. Strategically accepting marginal offers, based on balancing donor criteria with recipient characteristics allows us to accept a greater number of import offers. Source: ¹National Kidney Foundation 2Keck Hospital of USC

3 Objective: 1. Define Current Practice 2. Developing Organ Offer Strategies Evaluate Results 3. Summarize: Challenges and Benefits 3Keck Hospital of USC

4 Define Current Practice Sharon Norfles, RN, BSN 4Keck Hospital of USC

5 Total Kidney Transplants Deceased Donor Living Donor All 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt Keck Hospital of USC

6 Kidney Demand vs. Supply 120,000 Waiting List Kidneys Removed Difference 100,000 80,000 60,000 40,000 20, Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt United Network for Organ Sharing: Wait List Candidates by Organ Type All States July 2, Keck Hospital of USC

7 Kidney Transplant Candidates are Getting Older >=75 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt Keck Hospital of USC

8 The Waiting Times Are Increasing 100% < 1 year 1-< 2 2-< 3 3-< 4 4-< 5 >= 5 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt Keck Hospital of USC

9 Kidney Waitlist % 20% 15% 10% 5% 0% < 30 Days 30 to 90 Days 90 Days to 1 Year 6 Months to 1 Year 1 Year to 2 Years 2 Years to 3 Years 3 Year to 5 Years 5 or More Years Source: United Network for Organ Sharing: Wait List Candidates by Organ Type All States July 2, Keck Hospital of USC

10 Kidney Organ Waitlist by State: Waitlist is 3 Years to 5 Years Source: United Network for Organ Sharing: Wait List Candidates by Organ Type All States July 2,

11 Kidney Organ Waitlist by State: Waitlist is More Than 5 Years Source: United Network for Organ Sharing: Wait List Candidates by Organ Type All States July 2,

12 Deceased Donor Kidney Donation Rates (per 1,000 Deaths) Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

13 Three-Year Outcomes for Adults Waiting for Kidney Transplant New Listings in 2011 Still waiting Removed from list Died DD transplant LD transplant 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

14 Kidneys Recovered 17,000 16,500 16,000 15,500 15,000 16,408 14,500 15,007 15,449 14, Source: United Network for Organ Sharing: Wait List Candidates by Organ Type All States July 2,

15 Recovered Kidneys Usage 18,000 All Kidneys Transplanted All Kidneys Recovered but not Transplanted 16,000 14,000 12,000 10,000 2,734 2,888 3,157 8,000 6,000 4,000 2,000 12,273 12,561 13, Source: United Network for Organ Sharing: Wait List Candidates by Organ Type All States July 2,

16 The Percent of Discarded Kidneys is Growing 19.40% 19.20% 19.00% 18.80% 18.60% 18.40% 19.24% 18.20% 18.00% 17.80% 18.22% 18.69% 17.60% Source: United Network for Organ Sharing: Wait List Candidates by Organ Type All States July 2,

17 Percentages of Kidneys Not Transplanted Out of All Kidneys Recovered for Transplant 2014 Discharged Transplanted 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% KDPI <= 20\% KDPI 21-34\% KDPI 35-85\% KDPI > 85\% KDPI missing Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

18 Percentages of Kidneys Not Transplanted Out of All Kidneys Recovered for Transplant By KDPI KDPI <= 20\% KDPI 21-34\% KDPI 35-85\% KDPI > 85\% KDPI missing 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

19 Percentages of DCD Kidneys Not Transplanted Out of All Kidneys Recovered Donation after Brain Death Donation After Circulatory Death Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

20 Percentages of Kidneys Not Transplanted Out of All Kidneys Recovered for Transplant By Age < >= Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

21 Developing Organ Offer Strategies Sandra Felty RN, BSN, MSN, MHA 21

22 Given the Constraints on the Supply Side, and the Increasing Demand... There are two possible strategies that can be implemented to increase the utilization of the current kidney supply market: 1. Greater acceptance of marginal kidneys that are offered by local centers. 2. Initiate regional and national allocation earlier to the centers that are more likely to utilize marginal organs due to higher average wait times for transplant. 22

23 Percentages of Kidneys Not Transplanted Out of All Kidneys Recovered for Transplant 2014 Discharged Transplanted 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% KDPI <= 20\% KDPI 21-34\% KDPI 35-85\% KDPI > 85\% KDPI missing Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

24 More Patients Are Willing To Take Marginal Kidneys (Accept ECD or KDPI >85\% kidney) Yes No 100% 90% 80% 70% % 50% 40% 30% 20% 10% 0% Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

25 Over Time, Older Patients Have Become More Willing To Accept a Marginal Kidney 100% 90% >=65 80% % 60% 50% % 30% 20% 10% 0% Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

26 Graft Survival Among Adult Kidney Transplant Recipients (In Months) 2009, Deceased Donors KDPI <= 20\% KDPI 21-34\% KDPI 35-85\% KDPI > 85\% Source: Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Boyle, G., Snyder, J. J., Kasiske, B. L. and Israni, A. K. (2016), OPTN/SRTR Annual Data Report 2014: Kidney. Am J Transplant. 2016;16 (Suppl 2): doi: /ajt

27 Import Kidney Offers Accepted by USC y = x Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

28 Kidney Offers From Outside USC DSA , By KDPI Offer Not Accepted 0-20% 21-34% 35-85% % Missing Offer Accepted 0-20% 21-34% 35-85% % Missing Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

29 Accepted Kidney Offers From Outside USC DSA , By KDPI 0-20% 21-34% 35-85% % Missing 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

30 Kidney Offers From Outside USC DSA , By DCD Donor Status Offer Not Accepted Offer Accepted Not a DCD Yes a DCD Not a DCD Yes a DCD Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

31 Accepted Kidney Offers From Outside USC DSA , By Age Group Years Years 50+ Year Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

32 Accepted Kidney Offers From Outside USC DSA 2012, By State % 21-34% 35-85% % California Illinois Minnesota Nevada New York Peruo Rico Texas Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

33 Accepted Kidney Offers From Outside USC DSA 2013, By State % 21-34% 35-85% % Arizona California Indiana Louisiana Nevada Texas Utah Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

34 Accepted Kidney Offers From Outside USC DSA 2014, By State % 21-34% 35-85% % Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

35 Accepted Kidney Offers From Outside USC DSA 2015, By State % 21-34% 35-85% % Missing Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

36 Kidney Offers Accepted , By KPDI% and DSA Location Accepted by USC Outside DSA Location <20% 21-34% 35-85% >85% missing <20% 21-34% 35-85% >85% missing 60% 55.00% 60% 50% 50% 50.51% 40% 40% 30% 30% 20% 19.10% 15.40% 20% 15.93% 21.36% 10% 8.10% 10% 10.17% 2.40% 2.03% 0% 0% Source: UNITED NETWORK FOR ORGAN SHARING Organs offered to CAUH-TX1-KI Includes only organs that were transplanted. Matches run between October 1, 2010 and September 30,

37 Observed and Expected Deceased Donor Transplant Rates: 01/01/ /30/2015 Expected (Rate per 100 Person Year) Observed (Rate per 100 Person Years) US Region OPS/DSA This Center Source: Scientific Registry of Transplant Recipients Keck Hospital of USC. Release Data, June

38 First-Year Adult Graft and Patient Survival: 01/01/ /30/2015 Observed Expected Patient Deaths (265 Transplants) Graft Failures (289 Transplants) Source: Scientific Registry of Transplant Recipients Keck Hospital of USC. Release Data, June

39 Of Organs Transplanted at USC 31.0% were not from local DSA (20% national) 19.0% were from outside the state of California 21.0% were DCD 13.0% were ECD 72.3% were given to people aged over 50 50% of transplanted organs have a cold time in the range of hrs (vs. 37% nationally) 22.5% of kidneys were given to people aged over 65 (vs. 19.1% nationally) More transplants were performed than were expected (0.10% exp vs. 0.13% observed) One year graft survival was also higher than expected (94.2% exp vs. 96.8% observed) 39