Transplant Insider

Quarterly Publication by Guidry & East, LLC

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Is Your Transplant Center Prepared?
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CMS initiated the Conditions of Participation for Organ Transplant programs on June 28, 2007. Five of the 500+ Medicare Certified organ transplant programs were found to have "significant deficiencies that affect or had the potential for affecting the health and safety of transplant recipients and living donors". These centers completed a rigorous retooling mandated under an agreement with CMS referred to as a Systems Improvement Agreement ("SIA") to avoid losing Medicare certification.

Read more here .


This page provides basic information about organ transplant programs.  The CMS Conditions of Participation (CoP)s for organ transplant programs were established on March, 2007, and became effective on June 28, 2007.
  Winter 2018

Guidry & East brings you Transplant Insider, a quarterly publication comprised of resources and news vital to developing your transplant business solutions for growing transplant programs, improving transplant operations, and the transplant financial product line.

We look forward to being your provider of the latest policies and procedures in quality patient care.


Guidry & East has assisted approximately one-third of Transplant Centers cited under the  CMS Conditions of Participation with their quality systems improvements. The assistance falls in the securing of two categories of consultants: 
  • Independent Peer Review Team 
  • Onsite Transplant Consultant/s
If you believe you have outcome issues and your CUSUM reports are threading in the wrong direction or your projected SRTR shows that you will flag on 2 consecutive occasions within the last 5 SRTR release periods using the CMS criteria for flagging programs, you need to take action NOW!  You need to call us to prepare a pre-emptive  Independent Peer Review Team for your program without delay.  Our Independent Peer Review Team (six to eight consultants) will be of assistance to your center in highlighting both short term and long term areas of improvement as you develop your Transplant Program's Root Cause Analysis report. We can help!
Following the filing of your Mitigating Factors Application ("MFA") and with CMS's approval, you may find yourself in the position of accepting a Systems Improvement Agreement ("SIA") to maintain Medicare Certification for your transplant program.
Under an SIA you will be required by CMS to follow very tight time-lines, including the securing of an  Onsite Transplant Consultant/s to partner with the hospital-based transplant team for eight to ten days a month for the term of the SIA - generally one year. This  Onsite Transplant Consultant will observe and analyze the day-to-day operations of the entire transplant program, wait-list management, and assist the Transplant Center with the implementation of the  Independent Peer Review Team's recommendations.  
Guidry & East is a full service transplant consulting firm that goes beyond the norm to bring efficiency, improve financial results, and enhance quality patient care.  We recognize that because each Transplant Center is unique, so too are our consulting engagements.  Guidry & East designs each project based on the specific needs of the client Transplant Center, utilizing decades of experience and expertise.
Whether your center has been cited or not, we welcome the opportunity to listen and learn about the goals and objectives for your Transplant Center. It is likely that we offer services that are a great fit for you. Feel free to call or email to discuss how  Guidry & East may provide proven strategies and solutions within your Transplant Center.  

Latest News

Death, CVD, Type 2 Diabetes Not Increased for Living Kidney Donors
(HealthDay News) -- Living kidney donors have no increased risks for all-cause mortality, cardiovascular disease, hypertension, type 2 diabetes, or adverse psychological health outcomes, according to a review published online in the Annals of Internal Medicine.

Read  here.
Method Gauges Transplant Referral Among Dialysis Facilities
(HealthDay News) -- A standardized transplantation referral ratio (STReR) can assess clinical performance of transplant referral among  dialysis facilities, according to a study published online in the  Clinical Journal of the American Society of Nephrology.

Read  here.
Living Kidney Donors Need Support for Range of Emotions
(HealthDay News) -- Living kidney donors experience a wide range of emotions throughout the donation process that influences the lives of donors on several levels, according to a study published online in the  Journal of Renal Care .

Read  here.
Deceased Organ Donors in United States Exceeded 10,000 for First Time in 2017
During 2017, the number of deceased organ donors in the United States topped 10,000 for the first time, according to preliminary data from United Network for Organ Sharing (UNOS), which serves as the national Organ Procurement and Transplantation Network (OPTN) under federal contract. For the year, organs were recovered from 10,281 donors, representing a 3.1 percent increase over 2016 and an increase of 27 percent since 2007.

Read  here.
2018 National Donor Memorial Award for Excellence Call for Nominations
UNOS invites OPOs and transplant centers to submit nominations for the National Donor Memorial Award for Excellence, which recognizes an unsung hero (an individual or a couple). Nominees often are a donor parent, recipient, living donor or volunteer who has gone "above and beyond" in promoting organ donation and transplantation ... with little public recognition.

Read  here.
Voting Opens Feb. 7  for UNOS Board Election/Annual Meeting of Members
The 2018 Annual Meeting of Members of United Network for Organ Sharing will be held at 700 North 4th Street, Richmond, Virginia, March 7, 2018, at 10:00 a.m. (ET) for the following purposes:
  1. To elect Directors and Officers of the Corporation to serve for stated terms or until their successors are duly qualified and elected. Please note that the UNOS Board of Directors continues to function as the OPTN Board of Directors.
  2. To ratify amendments to the Bylaws of the Corporation, (summaries are available here), which have been adopted by the Board of Directors since the Annual Meeting of Members on March 8, 2018.
  3. To transact such other business as may properly come before the Annual Meeting or any adjournment thereof.
Read  here.
TIEDI System Enhancement to Add PX ID to Patient History Search Results
The following changes were implemented  February 7, 2018:
A new PX ID column has been added to the Patient History Search Results in the UNet SMTIEDI ® system.

We made this change because members told us that this tool will help them find patient information more quickly and easily.
In April 2017, we added the PX ID number as a search option to the Patient History search screen in TIEDI ®. Users can search patient history and identify patients from SRTR data reports.
This additional improvement gives users easy access to information about their patients on SRTR worksheets, without having to enter information for each patient.

Read  here.
Upcoming Pediatric Transplant Program Component Requirements
In December 2015, the OPTN/UNOS Board of Directors approved new requirements in the OPTN bylaws to establish a pediatric transplant program component for any program opting to list candidates younger than age 18. The approved bylaws include training and experience requirements for primary surgeons and physicians associated with the pediatric component.

Read  here.
Policy change: Automatic Approval of Exception Extensions for Certain HCC candidates
OPTN Policy 9.3.F (Extensions of HCC Exceptions) was amended February 5. It restored automatic approval for exception extension requests for a subset of HCC candidates with treated lesions that fall below the eligibility criteria for an initial exception request. Please note, however, that such candidates who came due for an exception extension between December 12, 2017 and February 4, 2018, must continue to receive regional review board approval for any subsequent extension requests.

Read  here.
Perioperative Antibiotic Prophylaxis to Prevent Surgical Site Infections in Solid Organ Transplantation
This review describes the epidemiology and risk factors associated with postoperative surgical site infections, proposing organ-specific guidance for the use of antibiotic prophylaxis considering individual risk factors and local patterns of resistance to minimize the increasing rates of antimicrobial resistance, adverse events, and costs.

Read full article  here.
Anti-CD20 Blocker Rituximab in Kidney Transplantation
The authors analyze the use of the anti-CD20 monoclonal antibody, rituximab, in various aspects of kidney transplantation including desensitization, treatment of humoral rejection, treatment of disease recurrence and posttransplant lymphoproliferative disease. Despite nearly 20 years of introduction and use in the field, solid data are still anticipated.

Read full article  here.
Preserving Treg Function: Beyond mTOR Inhibitors
When the antifungal compound rapamycin was discovered in 1972 within bacteria isolated from soil samples acquired on the South Pacific island of Rapa Nui, its future use in preventing transplant rejection could not have been predicted. As advancing research unearthed the evolutionarily conserved signal transduction pathway mTOR (mechanistic target of rapamycin), an understanding of the role of rapamycin in abrogating T-cell activation developed. 

Read full article  here.
The Cutting Edge of HLA Diagnostics
Since the 1950s, landmark twin transplant studies at the Peter Bent Brigham Hospital in Boston, Massachusetts, the critical role of histocompatibility has been evident.  Nevertheless, 2 pivotal advances in the 1960s were required to make transplantation across HLA barriers available to all patients with end-stage organ failure: (1) the identification of effective immunosuppressive combinations; and (2) the development of a diagnostic assay to detect preexisting recipient humoral memory to the donor, which if crossed, would lead to hyperacute allograft rejection.  Thereafter, the transplant community has seen continuous advances in both of these fields of study that have directly impacted patients by improving outcomes.

Read full article  here.
IgG Degrading Enzyme of Streptococcus Pyogenes: An Exciting New Development in Desensitization Therapy
For highly sensitized patients, desensitization and transplantation offer a significant survival benefit over remaining on dialysis or waiting on the list for a compatible donor.  Currently, there are 2 standard of care (SOC) approaches to desensitization: plasmapheresis with low-dose IVIg or high-dose IVIg. Both are associated with a higher rate of antibody-mediated rejection (AMR) and a reduced graft half-life when compared with HLA compatible transplants. Plasmapheresis is inefficient, only removing IgG from the vascular space and requiring a waiting period (usually 48 hours) for re-equilibration of IgG between the interstitial and vascular spaces to accomplish effective whole-body antibody depletion. Additionally, it is not durable, in as much as the antibody will rebound if the transplant is not performed and plasmapheresis is discontinued. For these reasons, it has only been efficacious for desensitization to a live donor where the time of transplant is known and therapy can be initiated well in advance.  The effect of IVIg appears to be more durable and can be initiated months before a transplant, making it more practical for deceased donor transplants where sensitized patients have a waiting time or allocation advantage. However, it is only nominally effective at reducing panel-reactive antibody and may not be efficacious for reduction of high strength HLA antibodies.  Thus, there is an unmet need for a desensitization modality that is immediate, potent, and efficient.

Read full article  here.

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Transplant Management Forum
April 24-26.
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