Updating Primary Kidney Transplant Physician Requirements Membership and Professional Standards Committee

What problem will the proposal solve? Fellowship training requirements have been foundation for key personnel requirements in Bylaws Requirements in the Bylaws have not evolved with nephrology fellowship training requirements Physicians completing transplant nephrology fellowship through “alternative pathway” can’t qualify through the OPTN’s primary kidney transplant physician fellowship pathway Fellowship training requirements have generally served as the foundation for key personnel requirements in OPTN Bylaws; however, primary transplant kidney physician pathways do not reflect some options and standards currently associated with transplant nephrology fellowships. For example, because the transplant nephrology fellowship pathway in the Bylaws specifies “12 months,” a primary transplant physician applicant who completed what is described as an “alternative pathway” fellowship, which lasts longer than 12 months, would not currently qualify as a primary kidney transplant physician through the OPTN Bylaws’ kidney physician fellowship pathway.

What are the proposed solutions? Add language to accommodate the transplant nephrology fellowship “alternative pathway” New patient case volume requirements Evaluate 25 potential kidney transplant recipients Evaluate 10 potential living kidney donors Minor Bylaws modifications for additional clarity To update the OPTN Bylaws to align with current transplant nephrology fellowship requirements, the MPSC recommends: adding language to accommodate the transplant nephrology fellowship “alternative pathway,” Adding two new patient evaluation requirements- 25 potential kidney recipients; 10 potential living donors, and other minor clarifications to these Bylaws.

Supporting Evidence Proposal stems from a Joint Societies Working Group (JSWG) recommendation Collaborative effort between AST, ASTS, NATCO, and the MPSC Fellowship training requirements have been foundation for key personnel requirements in Bylaws Critical requirements to complete a transplant nephrology fellowship have not been incorporated in Bylaws The recommendations included in this proposal were discussed by a Joint Societies Working Group, and are representative of a collaborative effort between AST, ASTS, NATCO, and the MPSC. Also, as previously mentioned, fellowship training requirements have historically served as the foundation for key personnel requirements in Bylaws, and critical requirements to complete a transplant nephrology fellowship have not been incorporated in Bylaws. To remedy this, the joint society working group referenced the Transplant Nephrology Fellowship Training Accreditation Program’s current fellowship requirements to update the OPTN Bylaws regarding primary kidney transplant physician requirements.

How will members implement this proposal? No immediate action required of members Membership applications received on or after the implementation date will be evaluated according to new requirements In addition to current requirements, primary kidney transplant physician applicants must have been directly involved in evaluating: 25 potential kidney recipients 10 potential living kidney donors No action will be required of members when these proposed changes are implemented. These proposed changes will not impact current primary kidney transplant physicians. The changes would impact how membership applications are reviewed AFTER implementation. At that time, primary kidney transplant physician applicants will be required to have been directly involved in the evaluation of 25 potential kidney recipients and 10 potential living kidney donors.

How will the OPTN implement this proposal? Board consideration- Dec. 2016 Programming – No Federal government must approve updates to membership application forms Implementation- MPSC will evaluate membership applications based on new requirements Monitoring- none Transition- changes do not impact current primary kidney physicians New requirements used to evaluate applications received on or after the implementation date If public comment is favorable, this proposal is slated to be considered by the OPTN/UNOS Board of Directors during its December 2016 meeting. Assuming the Board approves these changes, they would be effective after the federal government approves updates to the membership application and members have been notified. No programming is necessary to implement these changes. There is no monitoring associated with these proposed changes. Once the change is implemented, primary kidney transplant physician applicants that do not meet the new requirements will not be approved. To be clear, let me reiterate that these new requirements do not impact current primary kidney transplant physicians. Only the primary kidney transplant physician applications received on or after the to-be-determined implementation date will be evaluated based on the new requirements. Although these changes would not impact any current primary kidney transplant physicians, if an application is submitted after the implementation date that proposes someone who is currently a primary kidney transplant physician, as an example, for a new kidney program, then that application will be reviewed relative to these new Bylaws.

Questions? Jeffrey Orlowski, MS, CPTC Committee Chair Jorlowski@lifeshareok.org Chad Waller Committee Liaison chad.waller@unos.org