Impact of removing donation service area and region from pancreas allocation

Sarah E Booker; Katrina Gauntt; Jesse Howell; Joann White; Oyedolamu Olaitan; Rachel C Forbes

doi:10.1016/j.ajt.2024.03.006

Impact of removing donation service area and region from pancreas allocation

Am J Transplant. 2024 Mar 6:S1600-6135(24)00201-6. doi: 10.1016/j.ajt.2024.03.006. Online ahead of print.

Authors

Sarah E Booker¹, Katrina Gauntt², Jesse Howell², Joann White³, Oyedolamu Olaitan⁴, Rachel C Forbes⁵

Affiliations

¹ Research Department, United Network for Organ Sharing, Richmond, Virginia, USA. Electronic address: sarah.booker@unos.org.
² Research Department, United Network for Organ Sharing, Richmond, Virginia, USA.
³ Policy and Community Relations Department, United Network for Organ Sharing, Richmond, Virginia, USA.
⁴ Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA.
⁵ Department of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PMID: 38458363
DOI: 10.1016/j.ajt.2024.03.006

Abstract

On March 15, 2021, the Organ Procurement and Transplantation Network (OPTN) replaced donation service area (DSA) and OPTN region as units of pancreas (PA) allocation with a 250 nautical mile (NM) circle with proximity points. We analyzed OPTN data for kidney-pancreas (KP) and PA candidates, transplants, and donors in the 2 years pre-policy (March 16, 2019, to March 14, 2021) and post-policy (March 15, 2021, to March 14, 2023). As expected, more transplants occurred at hospitals outside the recovering organ procurement organization's DSA post-policy (KP: 32.1% vs 57.3%, P < .001; PA: 61.6% vs 69.3%, P = .09), but the majority stayed within 250 NM (KP: 79.7% vs 85.0%, P < .001; PA: 55.4% vs 61.5%, P = .19). Median preservation time increased from 9.5 to 10.3 hours for KP (P < .001); there was little change for PA (8.5 vs 8.6 hours; P = .99). There were no statistically significant differences in 1-year posttransplant patient mortality or graft failure after implementation for KP (mortality: 3.6% vs 3.2%, P = .60; kidney graft failure: 4.9% vs 5.0%, P = .95; PA graft failure: 9.5% vs 8.9%, P = .65) or PA (mortality: 1.7% vs 2.2%, P = .72; PA graft failure: 12.2% vs 12.6%, P = .88). The removal of DSA and OPTN region from PA allocation has resulted in broader distribution with minimal impact on preservation time or posttransplant outcomes.

Keywords: kidney-pancreas; organ allocation; pancreas; policy evaluation.