SECTION: Transplant ID NO.: TP-9-100 PAGE: 1 of 57 ISSUE DATE: February 14, 2019 ISSUE.REVISION: 1.11 REVISION DATE: July 28, 2021 APPROVED BY: Organ Authority POLICIES Wait list, organ offers and allocation Table of Contents 1. Introduction ......................................................................................................................................... 5 1.1 Trillium Gift of Life Network 5 1.2 Transplant System Governance 5 1.3 Allocation Policy Development, Amendment and Evaluation 6 1.4 National Organ Sharing Agreements 6 1.5 National Organ Waitlist Policy – Single Centre Listing 6 1.6 Guide to this Document 6 2. Organ Offers and Acceptance ............................................................................................................... 7 2.1. Organ Offers and Acceptance 7 2.2. Back-Up Candidates 7 2.2.1. Back-Up Candidates (Heart) 7 2.3. Organ Reallocation 7 2.4. Organs For Research 8 3. Kidney & Pancreas Policies ............................................................................................................... 9 3.1. Wait List Requirements and Statuses 9 3.1.1. Dialysis ..................................................................................................................................... 9 3.1.2. Medical Status ......................................................................................................................... 9 3.1.3. Wait List Suspension ............................................................................................................... 9 3.1.4. Serum Testing Requirements and Status ................................................................................ 9 3.1.5. Eligibility for the National Highly Sensitized Patient (HSP) Registry ..................................... 10 3.1.6. Out of Province Transfers ...................................................................................................... 10 3.2. Wait Time 10 3.2.1. Wait Time Calculations .......................................................................................................... 10 3.2.2. Wait Time Reinstatement....................................................................................................... 11 3.3. Allocation 11 3.3.1. Identifying Potential Recipients (Matching) ............................................................................ 11 3.3.2. Local and Provincial/National Allocation ................................................................................ 12 3.3.2.1. Local Allocation ...................................................................................................................... 12 3.3.2.2. Provincial/National Allocation ................................................................................................ 13 3.3.2.3. Allocation of Non-Directed Living Donor and List Exchange Donor Kidneys ........................ 13 3.3.3. Priority Categories for Matched Candidates .......................................................................... 14 3.3.4. Ranking & Allocation Points ................................................................................................... 14 3.4. Kidney Recovery Policies 15 3.4.1. Kidney Pumps ........................................................................................................................ 15 3.4.2. Left versus Right Kidney Allocation ....................................................................................... 15 3.5. Key Definitions 15 3.6. Kidney and Pancreas Policy Appendices 18 Appendix 3A: Virtual Crossmatch (VXM) Rules for Kidney Allocation ................................................ 18 Appendix 3B: Donor Hospital Regions for Local Kidney Allocation .................................................... 19 Appendix 3C: Kidney Allocation Tables .............................................................................................. 24 Table 1. Allocation of Kidneys from Donors < 4 years ........................................................................ 24 Table 2. Allocation of Kidneys from Donors < 35 years ...................................................................... 25 Table 3. Allocation of Kidneys from non-extended criteria donor ≥ 35 (non-ECD) ............................. 27 Table 4. Allocation of Kidneys from extended criteria donors (ECD) ................................................. 28 Table 5. Allocation of Kidneys from anonymous/living exchange (LE) living donors < 35 ................. 29 Table 6. Allocation of Kidneys from anonymous/living exchange (LE) living donors ≥ 35 ................. 29 2 4. Pancreatic Islet Policies .................................................................................................................. 30 4.1. Wait List Requirements and Statuses 30 4.1.1. Medical Status ....................................................................................................................... 30 4.1.2. Wait List Suspension ............................................................................................................. 30 4.1.3. Serum Testing Requirements and Status .............................................................................. 30 4.1.4. Out of Province Transfers ...................................................................................................... 30 4.2. Wait Time 31 4.2.1. Wait Time Calculations .......................................................................................................... 31 4.3. Allocation 31 4.3.1. Identifying Potential Recipients (Matching) ............................................................................ 31 4.3.2. Priority Categories for Matched Candidates .......................................................................... 31 5. Liver and Liver-Bowel Policies ........................................................................................................ 32 5.1. Wait List Requirements and Statuses 32 5.1.1. Medical Status ....................................................................................................................... 32 5.1.2. Wait List Suspension ............................................................................................................. 32 5.1.3. Lab Testing Requirements and Registration Status .............................................................. 32 5.1.4. Out of Province Transfers ...................................................................................................... 33 5.2. Wait Time 33 5.2.1. Wait Time Calculations .......................................................................................................... 33 5.3. Allocation 33 5.3.1. Identifying Potential Recipients (Matching) ............................................................................ 33 5.3.2. Local and Provincial/National Allocation ................................................................................ 34 5.3.2.1. Local Allocation (Locality Rule) .............................................................................................. 34 5.3.2.2. Provincial/National Allocation ................................................................................................ 34 5.3.3. Organ Offer Discussion – New High Status Listings ............................................................. 34 5.3.4. Split Procedures ..................................................................................................................... 35 5.3.5. Priority Categories for Matched Candidates .......................................................................... 35 5.3.6. Additional Ranking and Exception Points .............................................................................. 35 5.3.6.1. Exception Points .................................................................................................................... 35 5.4. Key Definitions 36 5.5. Liver and Liver-Bowel Policy Appendices 37 Appendix 5A: SMC and PELD Calculations ....................................................................................... 37 Appendix 5B: Locality Rule – Defined Donor Hospitals ...................................................................... 38 Appendix 5C: Exception Points ........................................................................................................... 38 6. Small Bowel Policies ........................................................................................................................ 41 6.1. Wait List Requirements and Statuses 41 6.1.1. Medical Status ....................................................................................................................... 41 6.1.2. Wait List Suspension ............................................................................................................. 41 6.1.3. Out of Province Transfers ...................................................................................................... 41 6.2. Wait Time 41 6.2.1. Wait Time Calculations .......................................................................................................... 41 6.3. Allocation 42 6.3.1. Identifying Potential Recipients (Matching) ............................................................................ 42 6.3.2. Priority Categories for Matched Candidates .......................................................................... 42 6.3.3. Additional Ranking ................................................................................................................