Intended audience: recipient coordinator transplant program admin

This reference topic provides detailed information about what happens “behind the scenes” when separate organ journeys are grouped as a cluster.

Area

Impact

Cluster holds

Organ 1 and organ 2 should be active on the waitlist at the same time to be considered for allocation.

If organ 1 is on the waitlist but organ 2 is in the medical assessment phase, then organ 1 gets a status of On Hold: Incomplete Cluster, which shows on the Waitlist history table.

In addition, the system displays a warning message in the waitlist area of each organ indicating an Incomplete Cluster Hold is in effect.

Medical hold

After the cluster has been established, any new Medical Hold applies to the whole cluster.  

Other (system) holds and suspensions

Organs added to the waitlist may have holds or suspensions determined for that individual organ. When each clustered organ is added to the waitlist, the system

  • Ends the existing holds and suspensions, and

  • Applies any applicable holds or suspensions to the entire cluster with a new start date.

After the cluster has been established, any new Hold or Suspension for one organ applies to the whole cluster.

SMC Override (for liver journeys)

If there is an SMC Score override on a liver being clustered or removed from a cluster, that override is removed and an email is sent to TGLN’s Special Case Committee mailbox.

Allocation

Recipients seeking a cluster generally get elevated priority on allocation

Wait time

Each component journey’s listing date is set to the later of:

  • the day the cluster was created.

  • the date a new organ was added to an existing cluster.

Journeys for heart, liver, lung, and small bowel accumulate wait time from that date. Journeys for Kidney and Pancreas can accumulate wait time from a dialysis start date. Refer to the Ontario Wait List, Organ Offers and Allocation Policy for details

Canada Transplant Registry

A waitlist status is pushed to the CTR so that the recipient can be considered in out of province allocations.

Donor Acceptability Criteria

Selected donor acceptability criteria are applied to the whole cluster (and thus impact allocations).

General Comments

The general comments from each organ in the cluster are merged into one comment. The merged comment appears on each organ journey.

Waitlist user interface

When viewing a clustered organ in the recipient’s journeys, a button to Un-cluster replaces the Save Cluster button.

Recipient profile > Referrals and Transplants

The Ontario Referrals and Transplants table presents a list of this recipient’s Ontario organ transplant journeys. The Clustered With column indicates which organs are clustered together.

Recipient listing

Recipient shows as waiting for a cluster of Organ1/Organ2 (e.g., Kidney/Pancreas)