Post on 13-Jan-2016
1
National Webinar to Review Non-Discussion Agenda
Fall 2015 Public Comment
If you are logged into the webinar, please enter the audio PIN
Please put your phone on MUTE and do not place this call on HOLD
2
Webinar Objectives
Review non-discussion agenda process
Present and discuss proposals on the non-discussion agenda
Review methods to submit feedback to sponsoring committees
3
Regional Meeting Goals Discuss and comment on proposed policies and bylaws
Collect feedback and provide to sponsoring committees Advisory to the councillor during Board deliberations
Executive Update on OPTN/UNOS activities
Receive updates on OPTN committee activities and projects
Discuss regional business
4
Regional Meeting Agenda Discussion Agenda
8 proposals presented, discussed, and voted on during meeting
Non-Discussion Agenda 4 proposals presented today No discussion at the regional meeting Regional Vote
Process for moving a proposal to the Discussion Agenda 15% of member institutions within a region submit a request All requests must be received one week prior to the regional meeting date If the 15% threshold is met, proposal will be presented and discussed during
regional meeting
5
Non-Discussion Agenda Proposals Proposed Changes to Transplant Program Key Personnel Procurement
Requirements (Membership and Professional Standards Committee)
Revising Kidney Paired Donation Pilot Program Priority Points (Kidney Transplantation Committee)
Proposal to Update the Human Leukocyte Antigen (HLA) Equivalency Tables (Histocompatibility Committee)
Proposal to Reduce the Documentation Shipped with Organs (Organ Procurement Organization Committee)
6
Changes to Transplant Program Key Personnel Procurement Requirements
Membership and Professional Standards CommitteeFall 2015
Update key personnel procurement Bylaws to: Correct unexplained inconsistencies Clearly establish requirements that are currently viewed as optional Remove unnecessary specificity Accommodate applications that the MPSC generally believes are acceptable,
but that it must reject due to current Bylaws requirements
Thereby, Simplifying the key personnel application process for members and the MPSC
What is the goal of the proposal?
7
Inconsistent primary surgeon procurement requirements
Solution: Delete primary kidney transplant surgeon multi-organ procurement
requirement Delete primary liver transplant surgeon donor selection and management
requirement
What problem will the proposal solve?
8
The word “should” means Primary transplant physician aren’t required to observe organ procurements
Solution: Use the word “must”
What problem will the proposal solve?
9
Questionable necessity of specifying primary transplant physicians must observe multi-organ donor procurements
Solution: Delete primary transplant physician multi-organ procurement
observation requirement
Exposure to multi-organ donors will likely occur without an explicit OPTN Bylaws requirement considering:
Proposed change that primary transplant physicians must observe at least three organ procurements
Multiple organs procured from the overwhelming majority of donors
What problem will the proposal solve?
10
Surgeons applying through fellowship pathway sometimes meet all requirements, but didn’t perform the requisite number of procurements during fellowship
Solution: Allow applying surgeons to cite procurements performed both
during their fellowship and 2 years after completion Otherwise, must apply through clinical experience pathway
What problem will the proposal solve?
11
Proposal stems directly from recommendations developed by a Joint Societies Working Group (JSWG)
Collaborative effort between: American Society of Transplantation (AST) American Society of Transplant Surgeons (ASTS) North American Transplant Coordinators Organization (NATCO) MPSC
Supporting Evidence
12
No immediate action required of members upon implementation
Membership and key personnel change applications submitted on or after the implementation date will be evaluated based on these requirements
Anticipated board review date – December 2015
Anticipated implementation date – March 2016
How will members implement this proposal?
13
Promote the efficient management of the OPTN
Proposal addresses key personnel procurement requirements that are: inconsistent unnecessarily specific needing additional flexibility
How does this proposal support the OPTN Strategic Plan?
14
15
Questions
Questions – click hand button
16
Questions?Committee Chair Jonathan Chen, MD jonathan.chen@seattlechildrens.org
Committee Liaison Chad Waller Chad.Waller@unos.org
Region 1 Rep David Axelrod, MD, MBA david.a.axelrod@hitchcock.org
Region 2 Rep Matthew Cooper, MD matthew.cooper@medstar.netmatthew.cooper@gunet.georgetown.edu
Region 3 Rep Thomas Pearson, MD, D.Phil. tpearso@emory.edu
Region 4 Rep Adam Bingaman, MD, PhD adam.bingaman@mhshealth.com
Region 5 Rep Lisa Stocks, RN, MSN, FNP lstocks@ucsd.edu
Region 6 Rep Christian Kuhr, MD christian.kuhr@vmmc.org
Region 7 Rep David Cronin II, MD, PhD, MHCM dcronin@mcw.edu
Region 8 Rep Timothy Schmitt, MD, FACS tschmitt@kumc.edu
Region 9 Rep Lewis Teperman, MD lewis.teperman@nyumc.org
Region 10 Rep Todd Pesavento, MD todd.pesavento@osumc.edu
Region 11 Rep Kenneth Brayman, MD, PhD, FACS klb9r@hscmail.mcc.virginia.edu
17
18
Revising Kidney Paired Donation Pilot Program Priority
PointsKidney Transplantation Committee
Fall 2015
19
What problem will the proposal solve?
20
What problem will the proposal solve?
How does the proposal address the problem statement?
21
Supporting Evidence
22
Increased the # of matching opportunities for 99% and 100% CPRA candidates
Prioritizing by pair characteristics increased the # of matching opportunities for hard to match pairs Blood type O candidates Candidate’s whose paired donor is non-O
Supporting Evidence – Overall Trends
23
Members participating in KPDPP will need to communicate the changes as a part of informed consent, particularly about the remedy for a failed exchange
Proposal does not require additional data collection
No changes to current routine site surveys
Anticipated Board Date: December 2015
Implementation Date: Pending programming
How will members implement this proposal?
24
Increase the number of transplants Increase # of matches found Incentivize transplant hospitals to participate Use data to improve chance of timely offers to candidates most likely to
accept
Improve equity in access to transplants Addresses increased difficulty in matching certain blood types and CPRA
levels Improves access for candidates in failed exchanges
How does this proposal support the OPTN Strategic Plan?
25
26
Questions
Questions – click hand button
27
Questions?Committee Chair Mark Aeder, MD mark.aeder@uhhospitals.org
Committee Liaison Melinda Woodbury Melinda.Woodbury@unos.org
Region 1 Rep Reginald Gohh, MD rgohh@lifespan.org
Region 2 Rep Alexander Gilbert, MD Alexander.J.Gilbert@gunet.georgetown.edu
Region 3 Rep Truman Earl, MD, MSCI tearl@umc.edu
Region 4 Rep Steven Potter, MD, FACS srpotter@etmc.org
Region 5 Rep Jonathan Fisher, MD, FACS fisher.jonathan@scrippshealth.org
Region 6 Rep Eric Langewisch, MD langewis@ohsu.edu
Region 7 Rep Didier Mandelbrot, MD damandel@medicine.wisc.edu
Region 8 Rep Clifford Miles, MD cdmiles@unmc.edu
Region 9 Rep Vinay Nair, DO vinay.nair@msnyuhealth.org; vinay.nair@mountsinai.org
Region 10 Rep Joshua Augustine, MD joshua.augustine@uhhospitals.org
Region 11 Rep Vincent Casingal, MD vincent.casingal@carolinashealthcare.org
28
29
Proposal to Update the HLA Equivalency Tables
Histocompatibility CommitteeFall 2015
30
What problems will the proposal solve? Some equivalences have changed since last update
Proposed solution - update equivalency tables based on: advances in HLA typing the frequencies of antigens reported for donors and antigens and unacceptable
antigens reported for candidates
Some HLA antigen dropdowns in UNetSM disadvantage candidates with antibodies against some alleles but not all of them Proposed solution - update dropdowns in UNet
Policy references to HLA DPB, DQA, and DQB are out of date Proposed solution – change policy references to these loci to DPB1, DQA1, and DQB1
Increase opportunities for candidates to receive offers Compatible donors will not be excluded based on outdated or broad
HLA typing constraints of prior equivalency tables
Reduce risk of positive crossmatch after shipping kidneys nationally and regionally
What is the goal of the proposal?
31
Supporting Evidence
32
Broad antigens reported for deceased donors (2013-2014)
* C3 was reported by 33 labs for 264 donors. Note: Labels show the number of labs for each broad antigen.
Transplant Programs: Request updated HLA typing using molecular methods for existing
candidates who may be affected by the changes to the equivalences tables
Review/modify unacceptable antigens reported for candidates with antibodies against alleles that are being added
Labs: Assign split (not broad) antigens to candidates
How will members implement this proposal?
33
Strategic Goal ImpactIncrease the number of transplants Improve efficiency of allocation for sensitized
candidates
Improve equity in access to transplants
Allow members to enter more specific data to ensure candidates are not excluded from donors against whom they don’t have UAs
Improve waitlisted patient, living donor, and transplant recipient outcomes
• Table updates will lead to better compatibility and decrease probability of post-transplant rejection
• Allocation to candidates less likely to have a positive crossmatch reduces cold ischemia time
Promote living donor and transplant recipient safety
Reduce risk of organ discards due to futile shipments
How does this proposal support the OPTN Strategic Plan?
34
35
Questions
Questions – click hand button
36
Questions?Committee Chair Dolly Tyan, PhD dtyan@stanford.edu
Committee Liaison Geoffrey Zindren Geoffrey.Zindren@unos.org
Region 1 Rep Indira Guleria, PhD iguleria@partners.org
Region 2 Rep Julie Houp, MS jgraz@jhmi.edu; juliehoup@jhmi.edu
Region 3 Rep Gabriella Wheeler, PhD gabriella.henel@piedmont.org
Region 4 Rep Chantale Lacelle, PhD chantale.lacelle@utsouthwestern.edu
Region 5 Rep Dolly Tyan, PhD dtyan@stanford.edu
Region 6 Rep Diane Kumashiro, MS, CHS, CLS dkumashiro@hcttl.org
Region 7 Rep Manish Gandhi, MD gandhi.manish@mayo.edu
Region 8 Rep Brian Freed, PhD, D(ABHI) brian.freed@ucdenver.edu
Region 9 Rep Allen Norin, PhD allen.norin@downstate.edu
Region 10 Rep Sam Ho, PhD, D(ABHI) sho@giftoflifemichigan.org
Region 11 Rep Peter Lalli, PhD, D(ABHI) peter.lalli@carolinashealthcare.org
37
38
Proposal to Reduce the Documentation Shipped with
OrgansOrgan Procurement Organization Committee
Fall 2015
39
What problem will the proposal solve? Current policy requires OPOs to send complete donor record with
each organ
Requirement originated before OPOs could upload information into DonorNet®
During the TransNetsm project, UNOS staff members observed attempts to make copies of documentation, often interrupting donor management
Free up OPO staff to concentrate on donor management and packaging and shipping quality by eliminating requirements to include documentation they have already provided to transplant centers
What is the goal of the proposal?
40
Reduces the need to copy and ship documentation already provided to transplant programs Blood type documentation (including subtype if used for allocation) and
infectious disease testing results will still be packaged with each organ Death pronouncement source documentation, authorization for donation source
documentation, human leukocyte antigen (HLA) type, donor evaluation and management, donor medical and behavioral history, and organ intraoperative findings will be provided in DonorNet upon receipt
Transplant programs can accurately and completely evaluate donor suitability using information provided in DonorNet
How does the proposal address the problem statement?
41
OPOs must: Submit deceased donor information to UNOS upon receipt so transplant
programs can evaluate donor suitability Still include source documentation for blood type and infectious disease testing
with each organ
Transplant hospitals must: Be aware that deceased donor information is available in DonorNet and can
print copies if necessary
The proposed language will not change the way UNOS conducts its routine site surveys
How will members implement this proposal?
42
Strategic Goal: Promote the efficient management of the OPTN Allow for more efficient and timely communication of donor
information using DonorNet instead of paper documentation that gets packaged and shipped with each organ.
How does this proposal support the OPTN Strategic Plan?
43
44
Questions
Questions – click hand button
45
Questions?Committee Chair Sean Van Slyck, MPA, HAS, CPTC svanslyck@dnwest.org
Committee Liaison Robert Hunter Robert.Hunter@unos.org
Region 1 Rep Jill Stinebring, RN jill_stinebring@neob.org
Region 2 Rep Debbie Williams, MBA, BSN, RN, CPTC dwilliams@thellf.org
Region 3 Rep Giridhar Vedula, MD giridhar.vedula.md@flhosp.org
Region 4 Rep Janice Whaley, MPH, CPTC jwhaley@lifeshareok.org
Region 5 Rep Sindhu Chandran, MD sindhu.chandran@ucsf.edu
Region 6 Rep Stephen Kula, PhD, NHA skula@legacyoflifehawaii.org
Region 7 Rep J. Kevin Cmunt, BS, MS kcmunt@giftofhope.org
Region 8 Rep Diane Brockmeier, RN, BSN, MA dbrockmeier@mts-stl.org
Region 9 Rep Rebecca Milczarski, MSN, MBA, CPTC rebecca_milczarski@urmc.rochester.edu
Region 10 Rep Daniel Lebovitz, MD danl@lifebanc.org; dlebovitz@lifebanc.org
Region 11 Rep Dwayne Jolly d.jolly@kodaorgan.org
46
Opened August 14
Closes October 14
Proposals are posted on the OPTN website under “Governance” tab
http://optn.transplant.hrsa.gov/governance/public-comment/
Fall 2015 Public Comment
47
Submit comments on the OPTN website http://optn.transplant.hrsa.gov/governance/public-comment/
Communicate with your regional representative http://optn.transplant.hrsa.gov/converge/members/committees.asp
Providing Feedback
48
Regional Meeting Information
49
http://transplantpro.org
Region Regional Administrator Phone Number Email
1,4,9 Shannon Edwards 804-782-4759 Shannon.Edwards@unos.org
2,6,8 Betsy Gans 804-782-4814 Betsy.Gans@unos.org
3,11 Cliff McClenney 804-782-4742 Clifton.McClenney@unos.org
5,7,10 Chrystal Graybill 804-782-4631 Chrystal.Graybill@unos.org
Regional Administrators Contacts
50