On May 19, 2006, the Organ Procurement and Transplant Network (OPTN) and United Network for Organ Sharing (UNOS) issued a notice soliciting public comments on seven policy proposals. These proposals address issues considered during recent meetings of the Kidney Transplantation Committee, Living Donor Committee, Membership and Professional Standards Committee, Operations Committee, OPO Committee, Policy Oversight Committee, and Transplant Coordinators Committee. Below is ANNAs response to the policy proposals. Proposal #1 Proposed Modifications to OPTN/UNOS Policy 18.104.22.168 (Time of Waiting) (Kidney Transplantation Committee) This proposal would require physicians to provide the date candidate start dialysis for pediatric kidney candidates, even though this date does not currently affect allocation priority for these candidates under national policy. The intent is to more consistently collect this important information. ANNA voted to support this proposal. Proposal #2 Proposed New OPTN/UNOS Policy 7.3.3 (Submission of Living Donor Death and Organ Failure Data) (Living Donor Committee) This proposal will make it a requirement for transplant centers to report live-donor deaths and failure of the live donors native organ function within 72 hours of becoming aware of such events. The intent of the policy is to require a more timely reporting of serious events that affect the well-being of living donors. ANNA voted to support this proposal. Proposal #3 Proposed Modifications to the Bylaws, Appendix B, Attachment I, Section XIII Live Donor Transplant Programs, Section B Live Donor Liver Transplant Programs. (Membership and Professional Standards Committee) This proposed Bylaw change is intended to provide live donor liver programs with the alternative of a conditional pathway for approval. This proposal was approved by the Board of Directors effective March 23, 2006 and concurrent with public comment. Additionally, the Board agreed that the criteria shall be applied retroactively to Live Donor Liver applications received since March 1, 2005. ANNA voted to support this proposal. Proposal #4 Proposed Modifications to OPTN/UNOS Policy 3.4.1 (Time Limit for Acceptance) and Policy 7.6.1 (Validation of Offers) (Operations Committee) The proposed policy changes specify the processes and member responsibilities for using the electronic organ placement system (DonorNet®2007) that is currently under development. Processes addressed by these proposals include: acknowledging receipt of the electronic organ offer; establishing time limits for acknowledging the organ offer, reviewing the donor information, and communicating a response regarding the organ offer; and defining the data entry and validation responsibilities for patient-specific refusal reasons. The objective is to update current policy to reflect the new practices that will be needed for an electronic organ placement system to function in the most efficient, expedient and consistent manner with the new system specifications. ANNA voted to support this proposal. Proposal #5 Proposed Modifications to OPTN/UNOS Policy 3.2.4 (Match System Access) (OPO Committee) The Organ Procurement Organization (OPO) Committee is proposing changes to the current documentation requirements for donor ABO data verification. These proposed changes would standardize the verification process across all OPOs; reduce the risk of discrepancy between UNetsm system logs and separate OPO documentation; and support the efficiency and safety of the verification and documentation process. ANNA voted to support this proposal. Proposal #6 Proposed Modifications to Data Elements on UNetSM Transplant Candidate Registration (TCR), Transplant Recipient Registration (TRR), Transplant Recipient Follow-up (TRF), and Post-Transplant Malignancy (PTM) Forms (Policy Oversight Committee) See Appendices A-F. The proposed changes to the UNetsm data collection forms are intended to streamline OPTN data collection and reduce the data collection burden on the transplant centers. The decision to keep or remove an item that is currently collected was based upon the OPTN Principles of Data Collection, which include (1) OPTN contractual obligations; (2) allocation of organs; (3) policy compliance monitoring; (4) policy development; (5) assessment of institutional performance; and (6) patient care. Recommendations from HRSA, CMD, USRDS, SRTR, and the ASTS/AST Task Force have been considered along with input from OPTN Committees. ANNA voted to support this proposal. Proposal #7 Proposed Modification to OPTN/UNOS Policy 3.3.6 (Center Acceptance of Organ Offers) (Transplant Coordinators Committee) This proposed policy change would bring greater consistency in the way organs are allocated when the Donation After Cardiac Death (DCD) donor deteriorates to neurological death, and ensures that every donation opportunity is pursued. The change requires OPOs to reallocate organs according to OPTN/UNOS policies 3.5 3.11 to the highest ranked transplant candidate when this situation occurs. OPOs will initiate the allocation of organs that may have been ruled out (i.e. heart, lungs, and pancreas) due to the donors previous DCD status, resulting in more organs for transplant. ANNA voted to support this proposal.