Christie Thomas, MD, FRCP, FASN, FAHA Regional Councillor Region 8 Meeting Christie Thomas, MD, FRCP, FASN, FAHA    Regional Councillor Welcome to the fall Region 8 meeting. We know you took time out of your schedule to be here and your attendance is appreciated.

Purpose of Regional Meeting Discuss regional business Provide updates on OPTN/UNOS committee activities and projects Discuss and comment on proposed policies and bylaws Provide suggestions or alternatives to any proposals not supported The purpose of regional meetings is to: discuss regional business receive updates on committee activities and projects discuss and comment on proposed policies and bylaws. Regional feedback on committee proposals and updates will be provided to the sponsoring committees. In addition to comments and votes, if the region does not support one of the proposals, it is helpful for the committee to hear what the region would support.

Regional Business Summary of spring 2016 regional meeting Summary of regional meeting includes: Sponsoring committee’s response to regional comments on proposals Board action on each proposal Implementation date if computer programming is not required A summary of the spring regional meeting is located in the booklet at your seat and is posted to Transplant Pro for your review. If you have suggested edits, please contact Betsy. The summary provides information about the proposals that we discussed at the spring meeting, and where they stand now. For each proposal, the summary includes the sponsoring committee’s responses to our region’s comments, the Board action taken on each proposal, and information about implementation. Implementation dates are not yet set for proposals that require computer programming.

Regional Business Spring public comment: January 23-March 24 (proposals reviewed by the Board in June) A tentative date for the spring meeting will be circulated to the region for feedback The regional meeting cycle is concurrent with the public comment cycle. The spring 2017 public comment cycle will begin on January 23 and end March 24. The public comment proposals we discuss during the spring regional meeting will be reviewed by the Board in June. Betsy will send an email to the region for feedback on a proposed spring meeting date in the next couple weeks.

Regional Business Councillor responsibilities Moderate regional meetings, oversee regional business Serve as the region 8 representative to the OPTN/UNOS Board of Directors Present the region’s comments on public comment proposals and other OPTN/UNOS matters To best represent the region, I need to hear from you Welcome other members of the Board of Directors As the regional councillor, I moderate regional meetings and oversee regional operations. Most importantly, I serve as the region 8 representative to the Board of Directors. I am the voice of the region at these 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 as my constituents. So, speak up today, and feel free to email or call me with any issues or concerns. I would like to take the opportunity to ask if there are any current Board members in attendance. If so, please stand and state your name and position on the Board.

OPTN/UNOS Committee Nominations Nomination period for regional representative nominations: September 12-October 12 Nomination announcement with link to online bio form will be sent by email and posted on the Transplant Pro website https://www.transplantpro.org/community/regions/region-8/ Nominations reviewed by Nominating Committee Regional recommendations considered by OPTN/UNOS President- Elect Appointments in April for terms beginning July 1 The nomination period for region 8 representative positions on committees begins September 12 and ends October 12. An announcement will be sent to the region in September and the information will be posted on Transplant Pro. All nominations must be accompanied by a candidate bio form to be considered. The bio form is online. The nominating committee is responsible for reviewing all nominations received from the region. The committee selection process is based on an individual’s professional experience, participation and engagement at a regional level, the needs of each committee for subject specific expertise, the ability of the candidate to represent the region at a national level, and the desire to have representation from as many areas of the region as possible. The Region 8 nominating committee consists of the Councillor, the Associate Councillor, the immediate past councillor and an OPO representative. Regional recommendations are considered and appointed by the OPTN/UNOS President-Elect. Committee appointments will be made in April for terms beginning July 1, 2017.

OPTN/UNOS Committee Nominations Liver & Intestinal Organ Transplantation Living Donor Membership & Professional Standards (Associate Councillor)* Minority Affairs Pediatric Transplantation Thoracic Organ Transplantation Here are the openings for terms beginning July 2017. All positions are 3 year terms except for MPSC which has a 2 year term. Note about MPSC: The Associate Councillor serves as the MPSC Representative. Per OPTN bylaws this is an elected position. The nominating committee has historically only considered candidates for this position if they have previous committee experience since this individual will serve as the Councillor and regional representative on the Board following their term on the MPSC. It is important that the candidates understand OPTN/UNOS processes.

Regional Meeting Agenda: Discussion Discussion agenda format is the same as previous meetings 10 public comment proposals Presentation Discussion Regional Vote The discussion agenda follows the same format as previous regional meetings. The regional representatives will present proposals today and the region will have an opportunity to discuss them. Following discussion, a vote will be taken on each proposal.

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 None received Proposals will be voted on today, but not presented or discussed Proposals presented and discussed during national webinars The proposals on the 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 with the aim of giving the regions more time to thoroughly discuss proposals that are controversial and have a larger impact on the community as a whole. The Regional Councillors and Administrators identified 2 proposals and 3 white papers that are anticipated to have a lower impact on the transplant community as a whole. In previous email correspondence, you were provided an opportunity to request that a proposal on the non-discussion agenda be added to the discussion agenda. The proposals on the non-discussion agenda will be voted on today, but they will not be presented or discussed.

National Webinars Two webinars were held to present and discuss the proposals and white papers on non-discussion agenda. August 23 and September 20 Two webinars were held to present summaries of the proposals and white papers. Members were given an opportunity to ask questions and provide feedback on the webinars.

Non-Discussion Proposals: Vote You have the option to abstain from voting if you haven’t reviewed the proposals Consider Primary Transplant Surgeon Requirement – Primary or First Assistant on Transplant Cases (Membership and Professional Standards Committee) Updating Primary Kidney Transplant Physician Requirements (Membership and Professional Standards Committee) Split Versus Whole Liver Transplantation (Ethics Committee) The Ethics of Deceased Organ Recovery without Requirements for Explicit Consent or Authorization (Ethics Committee) Ethical considerations of Imminent Death Donation (Ethics Committee) This slide includes a list of the proposals that we need to vote on today. **Read the title of each proposal** The plan is to take one vote on all 5 items unless anyone is opposed to a specific proposal. If you haven’t reviewed one of the proposals on this list and will abstain from voting or will vote to oppose a proposal, please raise your hand and we will vote on each proposal 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 all 5 items: yes, no, abstentions If hands are raised: vote on each proposal separately – yes, no, abstentions

Public Comment Proposals Public comment booklets on each table All attendees may discuss and provide feedback Each OPTN/UNOS member institution has one voting representative Sponsoring committee considers regional feedback in development of final proposal Board receives all public comment Your feedback is important! Public comment booklets containing the proposals we will discuss and vote on today are located at each table. Everyone may participate in the discussion and provide feedback. After each proposal is presented and discussed, a vote will be taken. Each OPTN/UNOS member institution receives one vote. OPTN/UNOS members include OPOs, transplant centers, histocompatibility laboratories, general public members, and professional organizations. A green card is provided to each voting member at the registration desk. 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.

Public Comment Opportunities Contact Regional Representatives http://transplantpro.org/community/regions/ Submit public comment online OPTN website: http://optn.transplant.hrsa.gov/governance/public-comment/ blog-style format, individual, regional, and committee comments are published If you have individual feedback on any of the public comment proposals, you have a couple ways to provide feedback. You can contact our region’s representative on 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. The public comment site provides a blog-type feature for public comment. To encourage public participation and transparency, the public comment site publishes submitted comments.

Regional Meeting Materials – online! The presentations shared today are posted online http://transplantpro.org/community/regions/ Make sure to review the presentations that weren’t presented today Histo, Minority Affairs, OPO, Pancreas, Pediatric, VCA Additional information available on this website including: Meeting agenda and summaries Data Links to various OPTN resources All of the committee presentations and meeting materials are posted 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.

Regional and National Data

U.S. Deceased Donation, 7/1/2014 – 6/30/2016   Donors Recovered Organs Recovered Organs Transplanted OTPD 7/1/2014-6/30/2015 8,836 31,111 26,909 3.045 7/1/2015-6/30/2016 9,513 33,746 29,111 3.06 % Change 7.7% 8.5% 8.2% 0.5%

U.S. Deceased Donors by Type and Region, 7/1/2014 – 6/30/2016 Regions 2, 3, 7, and 9 have the greatest percentages of ECDs with over 24%

Region 8 Deceased Donation, 7/1/2014-6/30/2016   Donors Recovered Organs Recovered Organs Transplanted OTPD 7/1/2014-6/30/2015 647 2,340 2,100 3.246 7/1/2015-6/30/2016 657 2,322 2,047 3.116 % Change 1.5% -0.8% -2.5% -4.0%

Region 8 Deceased Donors by Type, 7/1/2006 – 6/30/2016 17% NOTE: 2007=7/1/2006-6/30/2007; 2008=7/1/2007-6/30/2008; 2009=7/1/2008-6/30/2009; 2010=7/1/2009-6/30/2010; 2011=7/1/2010-6/30/2011; 2012=7/1/2011-6/30/2012; 2013=7/1/2012-6/30/2013; 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

Region 8 Deceased and Living Donors, 7/1/2006-6/30/2016 NOTE: 2007=7/1/2006-6/30/2007; 2008=7/1/2007-6/30/2008; 2009=7/1/2008-6/30/2009; 2010=7/1/2009-6/30/2010; 2011=7/1/2010-6/30/2011; 2012=7/1/2011-6/30/2012; 2013=7/1/2012-6/30/2013; 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

U.S. Deceased Donor Transplants, 7/1/2013 – 6/30/2016 NOTE: 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

Region 8 Deceased Donor Transplants, 7/1/2013 – 6/30/2016 NOTE: 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

Framing the day Full agenda 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 hold your comments and questions until the end of each presentation If the region opposes a proposal, specific feedback is valuable regarding the reason and what modifications could be made

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