Booker Sarah E, Howell Jesse, Dolan Thomas G, Poff Kelley, Laurie Krissy, Cherikh Wida S, Klassen David K, Wainright Jennifer L
Research Department, United Network for Organ Sharing, Richmond, VA, United States.
Policy and Community Relations Department, United Network for Organ Sharing, Richmond, VA, United States.
Front Transplant. 2024 May 16;3:1399357. doi: 10.3389/frtra.2024.1399357. eCollection 2024.
On 6/18/2020, the Organ Procurement and Transplantation Network (OPTN) implemented new policy replacing OPTN region with a 500 nautical mile (NM) circle around the donor hospital for the purpose of vascularized composite allograft (VCA) allocation. We used OPTN data to assess deceased donor VCA transplants in the 3 years pre- (6/19/2017-6/17/2020) vs. post-implementation (6/18/2020-6/17/2023). A total of 19 deceased donor VCA transplants were performed pre-policy (10 uterus, 3 bilateral upper limb, 1 unilateral upper limb, 3 face, 1 abdominal wall and 1 penis), and 11 post-policy (4 uterus, 1 bilateral upper limb, 2 face, 1 trachea, 2 abdominal wall, and 1 bilateral upper limb and face). Median distance from donor hospital to transplant hospital increased from 70 NM (range: 0-524 NM) pre-policy to 119 NM (range: 0-464 NM) post-policy. The majority of transplants in both policy eras were within 500 NM of the donor hospital [89.5% ( = 17/19) vs. 100% ( = 11/11)] and most remained within the same OPTN region as the donor hospital [68.4% ( = 13/19) vs. 90.9% ( = 10/11)]. Although it is difficult to draw strong conclusions about the policy's impact due to the low transplant volume and timing of implementation relative to the COVID-19 pandemic, data in the 3 years post-implementation suggest that 500 NM circles were a reasonable replacement for OPTN region in VCA allocation. The OPTN will continue to review data to monitor the policy's impact and inform future changes to VCA allocation, such as the transition to continuous distribution, a points-based framework expected to replace the current framework.
2020年6月18日，器官获取与移植网络（OPTN）实施了一项新政策，用围绕供体医院的500海里（NM）圆圈取代OPTN区域，用于血管化复合异体移植（VCA）分配。我们利用OPTN数据评估了政策实施前3年（2017年6月19日至2020年6月17日）与实施后（2020年6月18日至2023年6月17日）的已故供体VCA移植情况。政策实施前共进行了19例已故供体VCA移植（10例子宫、3例双侧上肢、1例单侧上肢、3例面部、1例腹壁和1例阴茎），政策实施后为11例（4例子宫、1例双侧上肢、2例面部、1例气管、2例腹壁以及1例双侧上肢和面部）。从供体医院到移植医院的中位距离从政策实施前的70海里（范围：0 - 524海里）增加到政策实施后的119海里（范围：0 - 464海里）。两个政策阶段的大多数移植都在供体医院的500海里范围内[89.5%（=17/19）对100%（=11/11）]，并且大多数仍与供体医院处于同一OPTN区域内[68.4%（=13/19）对90.9%（=10/11）]。尽管由于移植数量少以及相对于新冠疫情的实施时间，很难就该政策的影响得出强有力的结论，但实施后3年的数据表明，500海里圆圈在VCA分配中是OPTN区域的合理替代。OPTN将继续审查数据以监测该政策的影响，并为VCA分配的未来变化提供信息，例如向持续分配的转变，这是一个预计将取代当前框架的基于积分的框架。
