Managing the logistics of the new allocation policies
New allocation policies have not only increased the number of organ offers received by transplant centers but have also transformed the role of transplant coordination. Each organ offer requires not only careful review and conversations with the organ procurement organization (OPO), the patient, and the surgeon, but also increasingly complex transportation arrangements. As organs travel longer distances, transplant coordinators must also make decisions about whether to use a perfusion machine and, if a machine is deemed necessary, which machine is best suited to the identified mode of transportation. Thankfully, innovative solutions are springing up to meet the complex needs associated with the new allocation policies.
From donation service areas to continuous distribution
“Anything we can do to make it easier for the coordinators, I am all for,” says Megan Bell, BSN, RN, CCTC, Associate Director of Organ Transplant at Cedars-Sinai in Los Angeles, California. In 2006, she entered the transplantation field as the first supervisor of the University of California, Los Angeles ) Medical Center’s kidney transplant team. Ms Bell explains that, even 20 years ago, the job required balancing multiple factors and responding to an offer within an hour; however, the job was made easier by the smaller communities. “For so long, we really stayed in this little bubble where we collaborate with the OPOs we know,” says Ms Bell, adding that “it’s completely different from how it used to be.”
While once distributed within donation service areas defined by geographic boundaries, livers and kidneys are now allocated based on concentric circles as a transition phase before the organs are allocated via continuous distribution.1 These new approaches to allocation have made the coordinator’s job even more complex by further deemphasizing geography in organ offers. In 2023, lungs became the first organs to be allocated by continuous distribution. Such distribution paths, unbounded by geography, necessitated a corresponding increase in the ability of transplant centers to respond to an increased number of organ offers efficiently. Within months of initiating continuous distribution of lungs, the Organ Procurement and Transplantation Network put its efforts to establish continuous distribution of liver and kidney on hold as it investigated the effects of continuous distribution on organ transportation and nonutilization.
Creative solutions
“We have to be more creative,” explains Ms Bell. The transplant community is beginning to implement some of the newly developed creative solutions. One example of an innovative solution is MediGo, launched in 2020.4,5 The data analytics platform tracks the organ supply chain across the US, optimizing complex logistics from referral to recovery, including the critical movement of organs and teams. The hope is that MediGo will drive performance improvements by identifying logistics bottlenecks as well as opportunities to reduce procurement response times. In 2023, Fast Company named MediGo to its annual list of the world’s most innovative companies.
More recently, Pulse Charter Connect launched a digital platform to automate and streamline the inefficient process of organ transport logistics by interfacing with a verified network of charter vendors.6 To use it, transplant coordinators enter the details of the organ into the app, which then responds with transportation options, both air and ground. The Cedars-Sinai Accelerator program provided Pulse Charter Connect a boost when it awarded the company one of ten spots in its tenth class.7 The award, designed to help entrepreneurs bring innovative technology products to market, provides awardees with mentorship, designated office space, and a demonstration day.
Laura Epstein, MBA, founder and chief executive officer of Pulse Charter Connect, studied aerospace as an undergraduate. During her MBA, she learned about the challenges and high costs the transplant community faces when booking subbrokered, privately chartered flights. “We created a digital infrastructure for all of the coordination,” explains Ms Epstein. “Our goal is to make all of the process quicker, easier, and cheaper.”
As transplant coordinators strive to meet the logistical demands dictated by the new allocation system, these tools and others like them are welcome additions to the field. “It’s something we have to figure out,” emphasizes Ms Bell. “You never want transportation to be the reason you can’t match a patient with an organ.”
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