ISHLT Response to OPTN Modify Organ Offer Acceptance Limit
Published 11 September 2023
The International Society for Heart and Lung Transplantation (ISHLT) appreciates the opportunity to provide feedback on the “Modify Organ Offer Acceptance Limit” OPTN Public Comment proposal. Feedback was solicited from the ISHLT Advocacy Committee, the ISHLT Advanced Lung Failure and Transplant Interdisciplinary Network Steering Committee and the ISHLT Advanced Heart Failure and Transplant Interdisciplinary Network Steering Committee.
Although ISHLT recognizes the critical need to reduce organ non‐utilization, members raised concerns about the impact on waiting list mortality, particularly for critically ill and difficult to match thoracic organ transplant candidates. ISHLT believes that this blanket proposal restricting all candidates to a single primary offer acceptance is not appropriate unless mechanisms are put in place to allow exceptions. Moreover, ISHLT believes that considering criteria and exception pathways separately by organ will be needed to strike an appropriate balance between non‐utilization and waiting list mortality. ISHLT recommends that the committee develop organ specific exception criteria for difficult to match, critically ill candidates. Recognizing that backup recipients for DCD donors may be a particular challenge, ISHLT encourages the committee to consider including explicit conversations between transplant centers and OPOs when exceptions are needed to ensure that adequate backup candidates are in place.