OPTN board advances multiple policy projects to public comment, including HLA update, living-donor data and multi-organ allocation

The OPTN board voted to release a package of policy proposals for public comment, approving several items after discussion about costs, feasibility and potential downstream implementation needs.

Key items advanced for public comment included:

- HLA updating to 2025 (Histo Compatibility Committee): The committee recommended expedited implementation to optimize organ use. Some members questioned the cost (about $85,000 quoted during discussion) and whether existing workarounds reduce marginal benefit; Kathy noted the bylaws require annual updates to HLA equivalency tables. HLA update vote: 27 approve, 2 reject, 0 abstain.

- Improving living-donor data collection (Living Donor Committee): Proposal would add data on potential donors who did not donate and move long-term follow-up responsibilities to SRTR; POC scored it highly (93). Members flagged feasibility concerns and urged careful attention to center resource needs. Vote: 28 approve, 1 reject, 0 abstain.

- Pediatric heart transplant exception guidance (equipment shortage): This was implemented previously as an emergency action; staff explained the retrospective public-comment process for emergency actions and noted there is an end date tied to the emergency measure. Board discussion focused on supply-chain timing and potential sunset. Vote: 28 approve, 1 reject, 1 abstain.

- Require seasonal West Nile virus testing for all donors (DTAC): Board discussed epidemiology, seasonality, regional variation and the need for enforceable policy language; members said public comment would help refine dates, geography and operational details. Vote: 20 approve, 1 reject, 0 abstain.

- Establish comprehensive multi-organ allocation policy (Multi-Organ Transplant Committee): The proposal standardizes how multi-organ offers and match runs interdigitate. Members cautioned about modeling complexity, interaction with paused continuous distribution (CD) work, and the need for extensive post-implementation monitoring. Motion to send for public comment passed 23–6–0.

- Require patient notifications for waitlist status changes: The patient-affairs committee (patients, donors, donor families) strongly supported the proposal; board members discussed whether withholding public comment would effectively halt a project and recognized patient-affairs committee input. This project was approved for public comment; final vote in meeting announcements: 28 approve, 0 reject, 0 abstain.

Board members repeatedly emphasized that releasing a project for public comment does not commit the organization to implementation or to bearing full implementation costs; cost estimates will be updated and presented again before any final implementation vote. Several speakers asked staff and contractor representatives to clarify whether the cost estimates include implementation expenses; staff said the development estimates include public-comment facilitation and that implementation estimates will be refined later.

Quotes from the meeting capture the range of views. Kathy said, "we're mandated by the bylaws to update the HLA equivalency tables annually," defending the procedural obligation to advance that project. Lindsay (staff) explained the emergency-action process: "[emergency actions] were implemented immediately... there’s still cause to receive public comment... in case there were any unintended consequences." Justin and others stressed the need to examine implementation costs and center burdens before final implementation.

The board asked that updated cost estimates be provided during the development phase and reiterated that after public comment the projects would return to committees and the board for final votes on implementation.