U.S. Department of Health and Human Services
Recommendations 56 and 57
The Advisory Committee on Organ Transplantation (ACOT) met on September 4, 2013, on a conference call, and unanimously agreed on the following recommendations:
Recommendation 56: Recommendation for consideration to standardize brain death testing for children and adults.
The ACOT recognizes the importance of this recommendation since no national law exists for determination of brain death. ACOT encourages adoption of national guidelines for determination and documentation of brain death in infants, children, and adults.
ACOT recommends the following:
Recommendation 57: Kidney paired donation (KPD) plays an emerging role in the United States, now comprising more than 10% of live donor kidney transplants. The current decentralized organization of KPD programs is not optimal in terms of equity of access, broad participation by centers and patients, donor safety, and transparency. Providing a nationally accessible KPD system with incentives to participation in this system rather than in smaller, decentralized programs would improve equity of access and facilitate participation by centers and patients. Implementation of a standardized reimbursement model (such as a standard acquisition charge) would improve donor safety by ensuring medical care for donors, in addition to providing an equitable framework for reimbursement of KPD transplants. Evaluation of all KPD programs by a centralized group would improve transparency.
To address these issues, we recommend that the Secretary identify a national KPD contractor responsible for implementing a nationally accessible KPD system, identifying optimal matching strategies, and encouraging participation by all transplant centers. The contractor would also be responsible for (1) administering a standardized reimbursement model for KPD costs, donor workups, and post-donation medical care that would be available to centers fully participating in the system; (2) evaluation of KPD programs and transplant centers that choose to perform KPD outside of the national registry; (3) balancing the needs of current and future patients; (4) striving towards equity in patient access to kidneys; (5) ensuring quality through frequent and critical assessment of equity and efficacy; and (6) recommending process and/or policy changes as appropriate.