Adam Bingaman, MD, PhD Regional Councillor Region 4 Meeting Adam Bingaman, MD, PhD Regional Councillor Welcome to the fall Region 4 meeting. We know you took time out of your schedule to be here and your attendance is appreciated. I would like to thank the exhibitors for their support. Please stop by the exhibit tables and say “Hi”.

Meeting Agenda Update from OPTN/UNOS leadership Regional discussion session Texas Opt Out Bill Non-A1/non-A1B (A2/A2B) donor kidneys into blood group B candidates Review and discuss 5 public comment proposals Your feedback will be shared with the Kidney, Pancreas, OPO, and Liver Committees Updates on committee activities: Thoracic, Kidney, and Liver Committees Please note that we will be changing the order of the presentations on the agenda. The committees will present in the following order: Thoracic, Liver, OPO, Kidney, Pancreas Today’s meeting includes An update from OPTN/UNOS leadership A regional discussion session – this was a new addition to the spring regional meeting agenda. We received positive feedback on this session and are pleased to offer the opportunity today to discuss topics that are important to the region. Discuss and comment on proposed policies – your feedback will be shared with the sponsoring committees You will also hear updates from the Thoracic, Kidney, and Liver Committees. We have changed the order of the presentations to accommodate some of the presenters travel schedules.

Regional Business Summary of spring 2017 regional meeting Why should you review it? Committee’s response to our region’s comments Board’s action on each proposal Information on implementation date A summary of the fall regional meeting is located in the booklet at your seat and is posted to Transplant Pro for your review. The summary provides information about the proposals that we discussed at the spring meeting, and where they stand now. The summary includes each committee’s response to our region’s comments, the Board action taken on each proposal, and information about implementation. Implementation dates are not available for proposals that require computer programming.

Spring 2018 Regional Meeting Date Spring public comment: January 22 - March 23, 2018 proposals will go to the Board for review in June Mark your calendar! Spring region 4 meeting: Friday, February 23rd The regional meeting cycle runs concurrent with the public comment cycle. The spring 2018 public comment cycle will begin on January 22 and end March 23. The public comment proposals we discuss at the spring regional meeting will be reviewed by the Board in June. The spring regional meeting will be held in Dallas, TX on, Friday, February 23rd.

Region 4 Meeting Attendance Our goal is to have every institution represented at every regional meeting. We were above the national average last fall and just 1% under in the spring. I welcome any suggestions for how to engage more members.

Regional Business As councillor, my role is to: Chair the regional meetings Oversee regional business Serve as the region’s representative to the Board of Directors Share the region’s comments on public comment proposals To best represent the region, I need to hear from you Welcome members of the Board of Directors As the regional councillor, I chair the regional meetings and oversee regional operations. Most importantly, I serve as the region’s representative to the Board of Directors. I am the voice of the region at the board meetings, and present the region’s comments on public comment proposals and other OPTN/UNOS matters. In order to do this, I need to hear from you. To that end, speak up today, and feel free to email or call me with any issues or concerns. I would like to take the opportunity to introduce the Board members in attendance. When I say your name please stand and state your position on the Board. LIST BOARD MEMBERS Dr. Stuart Sweet Ms. Sue Dunn Ms. Tara Storch

OPTN/UNOS Committee Nominations Early September: call for nominations distributed for committee member openings in July 2018 Nominations accepted for all committee openings: regional representatives, at-large members Regional representatives: additional responsibility of serving as a liaison between the committee and the region presenting committee’s work at regional meetings representing the region’s comments at committee meetings In early September an official call for nominations will be sent to the region. However, you can apply for a committee or Board position anytime by visiting the OPTN website and completing a biography form. Nominations are being accepted for all committee openings, including regional representatives and at-large members. Both positions essentially have the same responsibilities, with regional representatives having the additional responsibility of being the liaison between the committees and the region. Regional representatives present updates on the committee’s work during regional meetings. They are also responsible for representing the region’s comments at committee meetings.

OPTN/UNOS Committee Nominations Interested individuals must submit a bio form online OPTN website Members tab Get Involved Bio form includes a section to indicate specific committee and Board interest, including the position(s) you are interested in New: If you submitted a bio form last Fall and were not appointed to a committee, you will be contacted to confirm your interest Interested individuals must submit a bio form online to be considered for a committee vacancy. The bio form is located on the OPTN website under the members tab. The bio form includes a section for individuals to indicate their committee and Board interests. You can also select whether you want to serve as a regional representative and an at-large member. You can select both positions if you are interested. If you submitted a bio form last Fall and you were not appointed to a committee, you will be contacted to confirm your interest. At that time you can indicate additional committee interests.

Committee Nominations: Regional Reps Bio forms for regional representative vacancies are due by October 20th Regional Nominating Committees meet in November Considerations: Professional experience Committee needs for subject-specific expertise Diversity in profession and demographics Ability to represent regional and national perspectives Past regional engagement Geographic balance in region Regional nominating committee selects the slate Ballot sent to regional voting representatives If you would like to be considered for a regional representative position on a committee, submit your bio form by October 20th. The regional nominating committee reviews all nominations received from the region. The committee will meet in November and develop the ballot for the election and the ballot will be distributed to the voting representatives in the region. The committee selection process is based on an individual’s professional experience, the needs of each committee for subject specific expertise, diversity in profession and demographics, the ability of the candidate to represent the regional and national perspectives, participation and engagement at a regional level, and the desire to have representation from as many areas of the region as possible. The regional nominating committee FYI – in case you need it, the nominating committee membership includes: the current Region 4 Councillor, Associate Councillor (Steve Potter), two individuals from Texas (Patti Niles and Muhammad Mujtaba), one individual from Oklahoma (Jeff Orlowski), and the Region 4 representatives to the Histocompatibility (Chantale Lacelle) and Thoracic Transplantation Committees (Shelley Hall).

OPTN/UNOS Committee Nominations To be considered for an at-large position, submit bio form by December 1 OPTN/UNOS President-Elect reviews regional and at-large recommendations Committee appointments final by March 1. New committee appointees will be contacted and will begin orientation and onboarding process Committee term begins on July 1, 2018 If you would like to also be considered for an at large member opening, submit your bio form by December 1. The President Elect of the OPTN and UNOS reviews regional and at-large recommendations and makes final appointments. Candidates who are appointed will be notified by March 1. Committee terms begin July 1, 2018.

Communication Efforts Email notices to the region Posted on the Region 4 page on Transplant Pro (Community Regions) Posted on OPTN and Transplant Pro websites Informational flyer at your table We are communicating the call for nominations broadly by emailing notices to each region and posting the information on the OPTN and Transplant Pro websites. Hand outs that include the information I shared on the committee openings are located at your table.

Region 4 Vacancies on Committees (terms begin July 1) Ethics Membership and Professional Standards (Associate Councillor) Here are the openings for terms beginning July 2018. With the exception of the MPSC/Associate Councillor position, all positions are 3 year terms.

Associate Councillor/Councillor-Elect Regional representative to the MPSC for a 2-year term (2018-2020) Councillor position for additional 2 years Serving as a liaison between the region and the OPTN/UNOS Board of Directors (Board member: 2020-2022) Chair regional meetings, manages regional operations, chairs the regional nominating committee Responsibilities and time commitment are significant Each region’s Associate Councillor serves as the regional representative to the Membership and Professional Standards Committee for a 2-year term. This individual serves an additional 2 year term as the regional councillor. MPSC Responsibilities: serves as the regional representative to the MPSC and stands in for the Regional Councillor as necessary MPSC meets three times a year for three day meetings, usually in Chicago MPSC has two standing subcommittees and each committee member is assigned to one The subcommittees and full committee meet by conference call as necessary.  Committee members are assigned to additional subcommittees and workgroups during their term.  Committee members are also expected to participate in the review of new program applications and key personnel changes, which require 2-4 hours of work per week. The Associate Councillor moves into the Councillor role for an additional 2 years. The Councillor is responsible for chairing regional meetings, leading regional nominating committee meetings, handling regional business, making decisions on behalf of the region, and representing the region on the OPTN/UNOS Board of Directors. Both of these roles come with a lot of responsibility and require a significant time commitment.

Associate Councillor/Councillor-Elect Selection process Same considerations as committee openings, PLUS: Past OPTN committee experience Board of Directors needs for diversity in profession, race, and gender Ability to take an organizational view Election process Nomination period closes October 20 Regional nominating committee selects the slate Ballot sent to regional voting representatives The selection process for the Associate Councillor/Councillor-Elect positions takes into consideration the same criteria as committee openings, but also includes past committee experience, the need for diversity in profession, race, and gender on the Board of Directors, and individuals who have the ability to take an organizational view. Board members have legal and fiduciary duties.  The Board sets the tone and direction for the organization and Board members act as trustees of OPTN and UNOS assets.  As stewards of the organization and public trust, Board members must act for the good of the OPTN and UNOS, rather than for the benefit of themselves.  When we say that we want someone who can take an organizational view, we mean that it is important to understand these legal and fiduciary duties that come with service on the Board. If you are interested in serving the region in this capacity, please submit your bio form online by October 20. The regional nominating committee will develop the ballot for the election and the ballot will be distributed to the voting representatives in the region.

Regional Meeting Agenda: Non-Discussion Includes proposals anticipated to be: non-controversial, minimal impact on the transplant community, and/or represent a clerical change to clarify policy or remain current with clinical practice Region was offered an opportunity to request that a proposal(s) be placed on the discussion agenda Proposals will be voted on today, but not presented or discussed Proposals presented and discussed during national webinars The proposals on the non-discussion (ND) agenda are anticipated to be non-controversial, have minimal impact on the donation and transplantation community, and/or represent a clerical change to clarify the intent of policy or to remain current with clinical practice. The ND agenda is developed to give the regions more time to thoroughly discuss proposals that are controversial and have a larger impact on the community as a whole. You were provided an opportunity to request that a proposal on the non-discussion agenda be moved to the discussion agenda. We didn’t receive any requests to remove the proposals we will vote on today from the non-discussion agenda. The proposals on the non-discussion agenda will be voted on today, but they will not be presented or discussed.

National Webinars Recordings posted on OPTN (Governance Public Comment) and Transplant Pro (Community Regions) websites Webinars held in August: non-discussion agenda items Webinars: discussion agenda items OPO and Liver Committees proposals on Aug 15 Kidney and Pancreas Committees proposals: September 12, 2:00 pm EDT Registration link on OPTN and Transplant Pro websites Two webinars were held in August to present summaries of the proposals, guidance documents, and white paper on the non-discussion agenda. Members were given an opportunity to ask questions and provide feedback on the webinars. Recordings of the non-discussion webinars are posted on the OPTN and Transplant Pro websites. Two webinars were scheduled to review and discuss the proposals on the discussion agenda. The first was held on August 15 and the OPO and Liver Committees proposals were discussed. A second webinar will be held on September 12 to review the Kidney and Pancreas Committees proposals. The registration link is also posted on the OPTN and Transplant Pro websites.

Non-Discussion Proposals: Vote You have the option to abstain from voting if you haven’t reviewed the proposals Living Organ Donation by Persons with Certain Fatal Diseases Who Meet the Criteria to Be Living Organ Donors (Ethics Committee) Review of HLA Tables (2016) (Histocompatibility Committee) Addressing Approved Transplant Fellowship Training Programs Bylaws (Membership and Professional Standards Committee) Guidance for Transplant Program Participation in the Transplantation of non-A1/non-A1B (A2/A2B) Donor Kidneys into Blood Group B Candidates (Minority Affairs Committee) This slide and the next one includes a list of the proposals on the non-discussion agenda that we will vote on today. **Read the title of each proposal**

Non-Discussion Proposals: Vote You have the option to abstain from voting if you haven’t reviewed the proposals Guidance on the Benefits of Pancreas After Kidney (PAK) Transplantation (Pancreas Committee) Revisions to Pediatric Emergency Membership Exception Pathway (Pediatric Committee) Regional Review Board Guidance for Adult Congenital Heart Disease Exception Requests (Thoracic Committee) The plan is to take one vote on the 7 items unless anyone is opposed to a specific proposal. If you will vote to oppose a proposal, please raise your hand and we will vote on each proposal separately, or vote on the proposal you don’t support separately. Note to councillors: **Please remind the group that they have the option to abstain if they didn’t attend one of the national webinars to hear the proposal presented or haven’t read the proposal online. If no hands are raised, take one vote on the 7 items: yes, no, abstentions If hands are raised: vote on each proposal separately – yes, no, abstentions

Public Comment Opportunities Share your comments today Contact Regional Representatives List is located in the meeting booklet and on Transplant Pro: select the community tab, and then “regions” Submit public comment online OPTN website: http://optn.transplant.hrsa.gov/governance/public-comment/ Sponsoring committee considers feedback in development of final proposal Board receives all public comment If you have feedback on any of the public comment proposals, you have a few ways to provide it. We want to hear your comments today. You can also contact our region’s representative to the sponsoring committee. A list of our region’s representatives is located in the booklet at your seat and also on the Transplant Pro website. You can also submit an individual public comment online through the OPTN website. Regional feedback is important as it is considered by the sponsoring committee when developing final proposals, and public comment proposals are often modified and improved based upon regional feedback. The Board also receives all public comment responses so that the directors have a sense of the transplant community’s sentiment about a given proposal.

Regional Meeting Materials – online! Today’s presentations are posted on Transplant Pro Make sure to review the non-discussion proposals and committee updates not presented today Histo, Living Donor, MPSC, Patient Affairs, Pediatric, Transplant Administrators, VCA Regional meeting materials are also posted on Transplant Pro All of the committee presentations and meeting materials are on the Transplant Pro website. A few committees did not present updates at today’s meeting. Please take time to review these presentations posted on the website. Meeting materials for today’s meeting are also posted on Transplant Pro.

Regional and National Data

Deceased Donation 2016-2017 U.S. Donors Recovered Organs Recovered   Donors Recovered Organs Recovered Organs Transplanted OTPD 2016 9,514 33,741 29,111 3.06 2017 10,201 35,930 31,081 3.047 % Change 7.2% 6.5% 6.8% -0.4%

Deceased Donors by Type and Region 2017 A relatively small percentage of donors recovered in Region 3 are from DCD, while at least 20% of donors in Regions 1 and 6 are DCD donors. Regions 2, 3, 7, and 9 have the greatest percentages of ECDs with over 24%

Deceased Donation 2016-2017 Region 4   Donors Recovered Organs Recovered Organs Transplanted OTPD 2016 1,050 3,738 3,263 3.108 2017 1,105 3,921 3,439 3.112 % Change 5.2% 4.9% 5.4% 0.1%

Deceased Donors by Type 2008-2017 Region 4 37%

Deceased Donor Transplants 2015-2017 U.S.

Deceased Donor Transplants 2015-2017 Region 4

Framing the Day We want feedback from as many attendees as possible To manage the discussion on each proposal, please limit your comments to new comments, points that haven’t been raised Please actively participate in the regional discussion session! If the region opposes a proposal, specific feedback and recommended modifications are valuable To be sure your comments and questions are heard, please use floor microphones

Framing the Day: Part 2 Instructions for webinar participants: Make sure to enter the PIN number located on the right-hand side of your screen, under the phone number If you want to speak, raise the hand feature located on the right hand side of your screen You will be called on in the order in which you raise your hand, please make sure to unmute your phone when we announce your name Keep in mind we may not call on everyone, we will manage the discussion period the best we can

Framing the Day: Part 2 All votes must be submitted by 3:00 p.m. today If you are participating remotely and are voting for your institution, email your votes to Shannon.Edwards@unos.org Only votes will be accepted, submit individual comments on the OPTN website: All votes must be submitted by 3:00 p.m. today In your email, clearly identify the proposal(s) you are voting for

Questions – click hand button To ask a question, click on the hand feature on the right hand side of your computer screen. We will unmute your phone line and call your name. Please remember to “un-mute” your phone as well.

Questions? Thank you for your attention and I am happy to answer questions.