Transcript Ad Hoc Disease Transmission Advisory Committee

Ad Hoc Disease Transmission Advisory
Committee:
A Report to the OPTN/UNOS Board
Emily A. Blumberg, MD, Chair
Michael D. Green, MD, MPH, Vice Chair
Shandie Covington, Staff Liaison
June 25-26, 2012
Richmond, Virginia
BOD Approved Committee Projects

DTAC News e-newsletter


Guidance for considering donor with
meningoencephalitis of unknown etiology


Ongoing as needed to share information
Reviewed at this meeting
Proposed Minimum Screening Requirements for
Living Donors

Feedback to Living Donor Committee on this proposal during development
Ongoing BOD Approved Committee
Projects

Improvements to disease reporting page on Improving
Patient Safety portal


Business Requirements being finalized, then to Exec Committee for
placement into programming queue
Follow-up survey of all OPOs regarding donor screening
practices

Remains on hold pending release of finalized US PHS Guidelines, as this is
expected to change OPO screening practices to some degree
US PHS Guidelines Update

CDC reviewed all responses received from Fall 2011
public comment period.

Overview of modifications to the Guidelines shared
publically at the American Transplant Congress talk on
June 5

Call with the Expert Review Panel held on June 11 to
review revised recommendations.

Feedback from call submitted no later than June 15.
Universal Donor Health Questionnaire

Multi-organizational stakeholder group worked on this
effort.


2 forms planned- adult and <12 y/o.


DTAC provided feedback early on and had an unofficial
representative on working group
Peds (<12 y/o) form still being finalized
Final adult document out and in beta testing phase now.

far more generally worded than AOPO format of medical-social
history
Potential Donor Derived Transmission
Events
7
Potential Donor Derived Transmission Events
2011
181
PDDTE
Infections
Other
Malignancies
126
4*
51
Proven/
Possible
Probable
10
20
Proven/
Possible
IWDT
IWDT
Probable
7
4
29
11
Unlikely/
Excluded
67
*all unlikely or excluded
Unlikely/
Excluded
29
Infections
Organism
# Donors
# Recipients
(proven/probable)
# Related Deaths
Bacteria (excl TB)
36
136 (3)
0
TB
14
42 (1)
1
HBV
13
35 (4)
0
HCV
11
34 (4)
0
3 (2)
12 (0)
0
Cryptococcus
10
27 (1)
0
Histoplasmosis
5
19 (1)
0
Candida
4
10 (0)
0
Aspergillus
2
8 (2)
0
Strongyloides/T cruzi
4
11 (4)
0
Other
24
92(12*)
5**
Total
126
426(31)
6
Resp Virus (Influenza)
* Scopulariopsis, LCMV, WNV, HHV8, CMV, Toxoplasmosis; ** Scopulariopsis,WNV, LCMV
Malignancies
Malignancy
# Donors
# Recipients
(proven/probable)
# Related Deaths
Renal
21
47 (2)
0
Adenocarcinoma
4
8 (1)
1
Lung/Pleural
4
17 (3)
3
Leukemia/Lymphoma
3
3 (1)
0
Liver
4
58(2)
0
Melanoma
2
6 (3)
2
Other
13
40 (4*)
1
Total
49
111 (16)
7
* Includes paraganglioma, choriocarcinoma, and urothelial cell carcinoma
What Has DTAC Learned?
Total # of
PDDTE
reported
2006
2007
2008
2009
2010
2011
TOTAL
60
97
102
152
157
181
749
13
(22%)
4
(4%)
16
(16%)
33
(22%)
30
(19%)
31
(17%)
127
17% of all
reported
PDDTE… but
<1% of all
donors
Total # of
Donors**
14,751
14,400
14,208
14,632
14,506
14,144
86,641
Total # of
Deceased
Donors**
8,019
8,085
7,990
8,022
7,943
8,127
48,186
Total # and %
classified as
proven or
probable*
* Subject to change after extended follow-up
**Cases reported include some donors recovered in previous
years.
DTAC 2011-2012
Dr. Emily Blumberg (Chair, TID)
Dr. Mike Green (Vice Chair, Peds TID)
Ms. Carrie Comellas (TX Coord)
Dr. Ed Dominguez (TID)
Dr. Afshin Ehsan(Thoracic Surgeon)
Barry Friedman (TX Admin)
Dr. Tom Gross (Peds Hem/Onc)
Dr. Dan Kaul (TID)
Dr. Shimon Kusne (TID)
Dr. Marshall Lyon (TID)
Dr. Rachel Miller (TID)
Ms. Samantha Mitchell (OPO)
Dr. Michael Nalesnik (Pathology)
Dr. Volker Nickeleit (Pathology)
Dr. Martha Pavlakis (Nephrology)
Dr. Tim Pruett (Abd TX Surgeon)
Dr. Phillip Ruiz (Pathology)
Dr. Michael Souter(OPO Med Dir)
Dr. Betsy Tuttle-Newhall (Abd Surgeon) Ms. Linda Weiss (OPO Lab Dir)
Dr. Russ Wiesner (Hepatologist)
Dr. Susan Hocevar (CDC)
Dr. Jim Bowman (HRSA)
Dr. Bernie Kozlovsky (HRSA)
Ms. Raelene Skerda (HRSA)
Dr. Karen Near (HRSA)
Questions?
Thank you!
Dr. Michael Green
Children’s Hospital of
Pittsburgh of UPMC
Incoming Chair
[email protected]
(412) 692-6111
Shandie Covington
UNOS
Sr. Patient Safety Specialist
Liaison
[email protected]
(804) 782-4929
Special thanks to Sarah Taranto, Kimberly Taylor, Kimberly
Parker, Cassandra Meekins as well as the entire Committee!
***RESOLVED, that the OPTN request a meeting with
the HHS to discuss the proposed U.S. Public Health
Service Guidelines for Reducing Transmission of
Human Immunodeficiency Virus (HIV), Hepatitis B
Virus (HBV) and Hepatitis C Virus (HCV) through Solid
Organ Transplantation before such guidance is
approved, in order to discuss the potential impact on
OPTN policies, in accordance with the Final Rule
§ 121.4 (2), which requires that OPTN policies be
consistent with recommendations of the CDC, for the
testing of organ donors and follow-up of transplant
recipients to prevent the spread of infectious
diseases.