I think it is important that Directors view these regulatory changes not from the perspective of practices at their own center but from a patient safety perspective – I would like to start a Discussion/Debate in this secure space with ASHI Directors.

Given the known limitations of our Luminex assays (serum interference, allele assumptions using low res HLA typing, shared epitopes leading to weaker reactivity on beads (ie Bw4) —I propose maintaining a physical crossmatch for HLA sensitized waitlist candidates to provide the broadest safety net.

Relying on Virtual Crossmatch only for candidates showing no HLA sensitization (majority of candidates) on sensitive immunoassays using at least 2 separate sera (safeguard for sample switch) and for whom the date of the most recent serum tested is in compliance with the transplant center's testing agreement (safeguard against re-activation of a candidate who has not had testing done in a long while).

Alternatively, maintain physical crossmatch for broadly sensitized candidates and all DSA+ cases would provide a more amenable regulation but would NOT provide the greatest patient safety given the limitations in our immunoassays.