national standard operating procedures

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Version 1.0 ATCA-TSANZ SOP 001/2013

National Standard Operating Procedures

Organ allocation Organ rotationsUrgent listings

THE TRANSPLANTATION SOCIETY OF AUSTRALIA AND NEW ZEALAND

Introduction 1

Purpose 1

Scope 1

Responsibility 1

Part A. General principles 21. 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 61. 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 QLD, NSW,

ACT, SA, WA and NT 11

6.3 Allocation process for VIC 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 141. 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 1.4Contactdetailsfornotification 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 2.4Contactdetailsfornotification 17

Appendices 18Appendix 1. Example of use—Heart rotation 18Appendix 2. Example of use—Lung rotation 19Appendix 3. Example of use—Lung rotation

for heart/lung bloc offers 20Appendix 4. Example of use—

Adult liver rotation 21Appendix 5. Example of template—

Interstate and New Zealand urgent heart listing 22

Appendix 6. Example of template— QLD urgent heart listing 23

Appendix 7. Example of template— Interstate and New Zealand urgent liver listing 24

Appendix 8. Example of template— QLD urgent liver listing 25

Version ControlSOP Reference 001Version number 1.0Review date May 2015Author Francesca RourkeApproved by ATCA Committee and TSANZ Council,

endorsed by OTADate approved May 2013co

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IntroductionThe 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.

PurposeThe purpose of the SOP is to facilitate the distribution and allocation of organs for transplantation in a fair and equitable manner.

ScopeThis 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.

ResponsibilityATCA/TSANZIt 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 AgencyIt 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 Donation Specialist Coordinators to maintain accuracy. intr

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PART A General principles 1. Organ allocation1.1 Non renal organ allocationa. 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 allocationa. 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.

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2. Urgent listingsUrgent 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 listinga. 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.

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.

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 NSW the other from VIC. The patient from NSW was listed first and the Victorian patient was listed two days later.

Scenario 1 QLD has a donor. The heart will be offered

first to the NSW patient. If NSW declines the offer, the heart will be offered to the Victorian patient. If declined then the heart will be offered to the QLD 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 VIC has a donor. The heart would be offered first to the Victorian home state transplant unit for their urgent patient. If declined by VIC, then the heart will be offered to the NSW patient. If declined then the heart will be offered to the Victorian

home state transplant unit. If declined by home state, the heart will go back on offer using the ATCA/TSANZ Heart Allocation Rotation.

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2.2 Urgent liver listinga. 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 11. 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 2a1. 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 2b1. 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 transplantsa. 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 programsa. 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, Donation Specialist Coordinator and retrieval teams.

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5. Recognised renal transplant units in Australia

Renal transplant units

QLDPrincess Alexandra Hospital—AdultsMater Children’s Hospital—Paediatric

NSW

The Children’s Hospital at WestmeadEast Coast Renal Transplant Service Prince of Wales Hospital and Sydney Children’s HospitalJohn Hunter HospitalRoyal North Shore HospitalStatewide Renal Services—Royal Prince Alfred HospitalWestmead Hospital

VIC

The Alfred HospitalAustin HospitalMonash Medical CentreRoyal Children’s HospitalThe Royal Melbourne HospitalSt Vincent’s Hospital

SARoyal Adelaide HospitalWomen’s and Children’s Hospital

WAPrincess Margaret Hospital for ChildrenRoyal Perth HospitalSir Charles Gairdner Hospital

6. Recognised extra renal transplant units in Australia and New Zealand

Heart transplant unitsQLD Prince Charles HospitalNSW St Vincent’s Hospital

VICAlfred Hospital—AdultsRoyal Children’s Hospital—Paediatric

WA Royal Perth HospitalNZ Auckland Public HospitalLung transplant unitsQLD Prince Charles HospitalNSW St Vincent’s HospitalVIC Alfred Hospital—Adults and PaediatricWA Royal Perth HospitalNZ Auckland Public HospitalAdult liver transplant unitsQLD Princess Alexandra HospitalNSW Royal Prince Alfred HospitalVIC Austin Hospital SA Flinders Medical CentreWA Charles Gairdner HospitalNZ Auckland City HospitalPaediatric liver transplant unitsQLD Royal Children’s HospitalNSW Children’s Hospital at WestmeadVIC Royal Children’s Hospital NZ Starship Children’s HospitalPancreas transplant unitsNSW Australian National Pancreas Transplant Unit Westmead HospitalVIC Australian National Pancreas Transplant Unit Monash Medical CentreNZ New Zealand National Pancreas Transplant Unit Auckland Hospital

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Part BOrgan allocation procedures1. Heart allocation1.1 Allocation proceduresa. 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.pa

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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 Numbers

QLD

Donation Specialist Coordinator On-Call via the PA Hospital switch board

07 3176 2111

NSWHeart/Lung Transplant Coordinator via On-Call mobile

0416 143 723

VIC

Royal Children’s Hospital: Heart Transplant Coordinator On-Call via RCH switch board

03 9345 5522

The Alfred: Heart/Lung Transplant Coordinator On-Call via the hospital switch board

03 9076 2000

WA

Heart Transplant Coordinator On-Call via Royal Perth Hospital switch board

08 9483 6999 Pager: 60 61 01

NZ

Heart/Lung Transplant Coordinator On-Call via Auckland City Hospital switch board

0011 6493074949

2. Lung allocation2.1 Allocation proceduresa. 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

QLD


07 3176 2111


0416 143 723

VIC

Heart/Lung Transplant Coordinator On-Call via the Alfred Hospital switch board

03 9076 2000

WA

Lung Transplant Coordinator On-Call via Royal Perth Hospital switch board

08 9483 6999 Pager: 60 40 07

NZ


0011 6493074949

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3. Heart/lung bloc allocation3.1 Allocation proceduresa. 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 Contact for heart/lung bloc offers Numbers

QLD


07 3176 2111


0416 143 723

VIC


03 9345 5522

The Alfred: Heart/Lung Transplant Coordinator On-Call via the hospital switch board

03 9076 2000

WA

Lung Transplant Coordinator On-Call via Royal Perth Hospital switch board

08 9483 6999 Pager: 60 40 07

NZ


0011 6493074949

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4. Liver allocation4.1 Allocation proceduresa. 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, NSW, 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).

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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

QLD


07 3176 2111

NSWLiver Transplant Coordinator via RPA Hospital switch board

02 9515 6111

VICLiver Transplant Coordinator via Austin Hospital switch board

03 9496 5000

WA

Donation Specialist Coordinator On-Call via Sir Charles Gairdner Hospital switch board

08 9346 3333

SA

Liver Transplant Coordinator via Flinders Medical Centre switch board

08 8204 5511

NZ Donation Specialist Coordinator On-Call

0011 6496 300935

5. Intestine/multivisceral allocation

5.1 General principlesa. 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 proceduresa. 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 Numbers


03 9496 5000

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6. Pancreas and islets allocation6.1 Allocation proceduresa. 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 QLD, NSW, 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 VIC and TASDonor 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 Zealanda. 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.

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6.5 General principlesa. 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 Numbers

NSW

Pancreas and islet offer: Pancreas Transplant Coordinator via Westmead Hospital Switch Board

02 9845 5555

VIC

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

03 9594 6666

Islet offer: Tom Loudovaris—Islet Transplant Coordinator via On-Call mobile

0418 382 987

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7. Kidney allocation7.1 Allocation proceduresa. 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 procedurea. When a kidney needs to be offered to an

interstate recipient it is the responsibility of the State Donation Specialist Coordinator to contact the appropriate person in the recipient state and provide the kidney offer referral.

b. The Donation Specialist 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 Contact for kidney offers Numbers

QLD Donation Specialist Coordinator On-Call 07 3176 2111

NSW Donation Specialist Coordinator On-Call 02 9963 2801

VIC Donation Specialist Coordinator On-Call 03 9347 0408

WA Donation Specialist Coordinator On-Call 08 9346 3333

SA Donation Specialist Coordinator On-Call 08 8378 1671

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PART CUrgent listing procedures1. Urgent heart listing 1.1 Listing a patient on the urgent heart

lista. 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: NSW 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 Donation Specialist Coordinator is notified. pa

rt c

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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 processa. 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 Recipient coordinator contacts Numbers

QLD

Heart/Lung Transplant Coordinator On-Call via the Prince Charles Hospital switch board

07 3139 4000

NSWHeart/Lung Transplant Coordinator On-Call via mobile

0416 143 723

VIC


03 9345 5522

The Alfred: Heart/Lung Transplant Coordinator On-Call via the Hospital switch board

03 9076 2000

WA

Heart Transplant Coordinator On-Call via Royal Perth Hospital switch board

08 9483 6999 Pager: 60 61 01

NZ


0011 64 9307 4949

State Donation specialist coordinator contacts Numbers






NT Donation Specialist Coordinator On-Call 08 8922 8888


0011 64 9630 0935

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2. Urgent liver listing 2.1 Listing a patient on the urgent liver

lista. 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 Donation Specialist 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: NSW 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 QLD, WA and the NT, where only the State Donation Specialist 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 QLD 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.

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2.3 Review and audit process

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.

2.4 Contact details for notification

State Recipient coordinator contacts Numbers

NSWLiver Transplant Coordinator via RPA Hospital switch board

02 9515 6111


03 9496 5000

SA

Liver Transplant Coordinator via Flinders Medical Centre switch board

08 8204 5511

NZ Liver Transplant Coordinator On-Call

0011 64 9307 4949

State Donation specialist coordinator contacts Numbers






NT Donation Specialist Coordinator On-Call 08 8922 8888


0011 64 9630 0935

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Appendix 1Example of use heart rotation

Explanation of rotation entries

1. Donor N1200: declined by QLD then offered to VIC. 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 QLD who accept. Heart allocated – end of rotation. Next state to receive an offer on rotation will be VIC.

3. Donor N1220: The VIC Adult unit will receive heart offer first which they decline. Offered next to VIC 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.

appe

ndix

a

Date Time Donor number

Donor hospital ABO AGE HT WT Donor

Coordinator Recipient Coordinator Rotation Code Comments

08/10/12 1930 N1200 Westmead A+ 17 159 52 Mary SmithTracey Wills

QLD 2 No ABO match

08/10/12 1950 N1200 Westmead A+ 17 159 52 Mary Smith

Lisa Black VIC (P) 1

VIC (A)

12/10/12 2300 N1215 Royal North Shore O+ 45 185 95 Jill AbleAnne Yellow

WA 2 No size/ABO match

12/10/12 2330 N1215 Royal North Shore O+ 45 185 95 Jill AbleSam Trebble

QLD 1

20/11/121600

1655N1220 RPA AB- 25 159 62 Kelly Skye

Kylie Blue VIC (A) 2 No group/size match

Lisa Black VIC (P) 2 Donor too big

20/11/12 1755 N1220 RPA AB- 25 159 62 Kelly SkyeAnne Yellow

WA 1

QLD

VIC (P)

VIC (A)

WA

QLD

VIC (A)

VIC (P)

WA

NSW HEART rotation

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 NSW Heart Rotation

a




08/10/12 1930 N1200 Westmead A+ 17 159 52 Mary SmithTracey Wills

QLD 2 No ABO match

08/10/12 1950 N1200 Westmead A+ 17 159 52 Mary Smith

Lisa Black VIC (P) 1

VIC (A)

12/10/12 2300 N1215 Royal North Shore O+ 45 185 95 Jill AbleAnne Yellow

WA 2 No size/ABO match

12/10/12 2330 N1215 Royal North Shore O+ 45 185 95 Jill AbleSam Trebble

QLD 1

20/11/121600

1655N1220 RPA AB- 25 159 62 Kelly Skye

Kylie Blue VIC (A) 2 No group/size match

Lisa Black VIC (P) 2 Donor too big

20/11/12 1755 N1220 RPA AB- 25 159 62 Kelly SkyeAnne Yellow

WA 1

QLD

VIC (P)

VIC (A)

WA

QLD

VIC (A)

VIC (P)

WA

NSW HEART rotation


ATCA-TSANZ SOP 001/2013 Version 1.0 NSW Heart Rotation

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Appendix 2Example of use lung rotation


1. Donor N1233: offered to and accepted by QLD. Lungs allocated – end of rotation. Next state to receive an offer on rotation will be VIC.

2. Donor N1240: offered to VIC. All lung offers are made to the Victorian Adult Unit at the Alfred. This is why the VIC (P) box in the “Lungs” column has “No offer required”. VIC declines the lungs. The lungs are then offered to QLD as the next state on rotation who accept the offer. Lungs allocated – end of rotation.




Lungs Heart lung bloc

05/01/12 1930 N1233 Westmead AB 35 164 65 Tracey WhiteMary Leate

QLD 1

15/01/12 2300 N1240 St George A 16 152 55 Lisa Black

Bill Wall VIC (A) 2 No size match

VIC (P) No offer

required

15/01/12 2345 N1240 St George A 16 152 55 Lisa BlackAmy Blue

QLD 1

VIC (P) No offer

required

VIC (A)

QLD

VIC (A)

VIC (P) No offer

required

QLD

VIC (P) No offer

required

VIC (A)

NSW LUNG rotation


ATCA-TSANZ SOP 001/2013 Version 1.0 NSW Lung Rotation





05/01/12 1930 N1233 Westmead AB 35 164 65 Tracey WhiteMary Leate

QLD 1

15/01/12 2300 N1240 St George A 16 152 55 Lisa Black

Bill Wall VIC (A) 2 No size match

VIC (P) No offer

required

15/01/12 2345 N1240 St George A 16 152 55 Lisa BlackAmy Blue

QLD 1

VIC (P) No offer

required

VIC (A)

QLD

VIC (A)

VIC (P) No offer

required

QLD

VIC (P) No offer

required

VIC (A)

NSW LUNG rotation



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Appendix 3Example of use lung rotation for heart/lung bloc offers


1. Donor N1240: heart/lung bloc offered to QLD. Lungs accepted and heart declined by QLD. Heart is then offered to the next state on the HEART rotation form.

2. Donor N1241: offered to VIC. 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. QLD is offered and accepts the lungs.

3. Donor N1250: VIC is first to receive the Bloc offer—the Victorian Paediatric Unit (VIC (P)) is first to receive the bloc offer. They accept the heart and decline the lungs. Lungs are then offered to VIC Adults Unit (VIC (A)) who decline. QLD is the next state on rotation to receive the offer of lungs, which they decline. This is the end of the allocation.





03/01/12 1930 N1240 RPA AB 35 164 65 Mary SmithTracey White

QLD 1 Lungs accepted Heart declined

08/01/12 2300 N1241 Westmead A 17 182 78 Sue Read

Lisa Black VIC (A) 1 Heart accepted

Lungs declined

VIC (P) No offerrequired

08/01/12 2300 N1241 Westmead A 17 182 78 Sue ReadTim Stone

QLD 1 Lungs accepted

13/01/12 1600 N1250 Lismore B 42 152 48 Mary Smith

Amy Wills VIC (P) No offer

required 1 Heart accepted Lungs declined

Lisa Black VIC (A) 2 Lungs declined

No match size

13/01/12 1700 N1250 Lismore B 42 152 48 Mary SmithTracey White

QLD 2&4 Lungs declined

VIC (A)

VIC (P) No offer

required

QLD

VIC (P) No offer

required

VIC (A)

NSW LUNG rotation







03/01/12 1930 N1240 RPA AB 35 164 65 Mary SmithTracey White

QLD 1 Lungs accepted Heart declined

08/01/12 2300 N1241 Westmead A 17 182 78 Sue Read

Lisa Black VIC (A) 1 Heart accepted

Lungs declined

VIC (P) No offerrequired

08/01/12 2300 N1241 Westmead A 17 182 78 Sue ReadTim Stone

QLD 1 Lungs accepted

13/01/12 1600 N1250 Lismore B 42 152 48 Mary Smith

Amy Wills VIC (P) No offer

required 1 Heart accepted Lungs declined

Lisa Black VIC (A) 2 Lungs declined

No match size

13/01/12 1700 N1250 Lismore B 42 152 48 Mary SmithTracey White

QLD 2&4 Lungs declined

VIC (A)

VIC (P) No offer

required

QLD

VIC (P) No offer

required

VIC (A)

NSW LUNG rotation



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Appendix 4Example of use adult liver rotation


1. Donor N1245: Liver is offered to QLD who decline. VIC 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, QLD and VIC 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.

NSW adult LIVER rotation Donor >18 years of age


ATCA-TSANZ SOP 001/2013 Version 1.0 NSW Adult Liver Rotation




06/02/12 1830 N1245 Westmead A 39 164 65 Mary Smith Tracey White QLD 3 Already transplanting, no team available

06/02/12 1850 N1245 Westmead A 39 164 65 Mary Smith Anne Yellow VIC 3 No surgeons available, 3 local donors

06/02/12 1940 N1245 Westmead A 39 164 65 Mary SmithKelly Green SA 2 No size matchAdam 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 QLD 2 No AB patient on list

01/03/12 2230 N1251 John Hunter AB 55 185 95 Polly Lime Anne Yellow VIC 2 Size and ABO mismatch

01/03/12 2300 N1251 John Hunter AB 55 185 95 Polly LimeAdam Gold WA 1 SA

05/05/12 2050 N1266 RPA O 25 162 65 Mary Smith Sally Ball NZ 1 QLD VIC SA WA NZ QLD VIC WA SA NZ

NSW adult LIVER rotation Donor >18 years of age


ATCA-TSANZ SOP 001/2013 Version 1.0 NSW Adult Liver Rotation




06/02/12 1830 N1245 Westmead A 39 164 65 Mary Smith Tracey White QLD 3 Already transplanting, no team available

06/02/12 1850 N1245 Westmead A 39 164 65 Mary Smith Anne Yellow VIC 3 No surgeons available, 3 local donors

06/02/12 1940 N1245 Westmead A 39 164 65 Mary SmithKelly Green SA 2 No size matchAdam 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 QLD 2 No AB patient on list

01/03/12 2230 N1251 John Hunter AB 55 185 95 Polly Lime Anne Yellow VIC 2 Size and ABO mismatch

01/03/12 2300 N1251 John Hunter AB 55 185 95 Polly LimeAdam Gold WA 1 SA

05/05/12 2050 N1266 RPA O 25 162 65 Mary Smith Sally Ball NZ 1 QLD VIC SA WA NZ QLD VIC WA SA NZ

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Appendix 5 Example of template Interstate and New Zealand urgent heart listing

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Appendix 6 Example of template QLD urgent heart listing

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Appendix 7 Example of template Interstate and New Zealand urgent liver listing

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Appendix 8 Example of template QLD urgent liver listing

national standard operating procedures

Documents