Action Items from the Kidney Transplantation Committee John J. Friedewald, MD Chair OPTN/UNOS Board of Directors Meeting June 25-26, 2012 Richmond, VA

Revisions to the Waiting Time Modification Policy

Problem Statement Current waiting time modification policy is not clearly written Consequences: Wasted time for tx center staff Missing or incomplete documentation (50% of all requests are initially received incomplete) Delays in error correction Current OPTN Policies regarding submission of waiting time modification requests are not clear, leading to wasted time for the transplant centers that submit requests, for OPTN Contractor staff who process requests, and for the Committees that review requests. Required documentation is often missing and results in delays for transplant candidates to receive the waiting time that they may be entitled to receive under OPTN policy. With these proposed clarifications, the Committee believes that it will receive fewer submissions of incomplete requests and be able to act on approved requests more quickly.

**No changes are proposed to the existing requirements or process. ** Proposed Solution Reword the policy so that requirements and process are clearly stated. **No changes are proposed to the existing requirements or process. ** The proposed policy language only clarifies the requirements and process for waiting time modification requests. No changes in the process or requirements for submitting a waiting time modification request are proposed. Transplant center staff who are responsible for submitting requests for waiting time modifications will need to be aware of the new policy language if/when it is approved by the Board of Directors. There are no changes proposed to the way that compliance with this policy will be monitored. The appropriate organ-specific committee(s) will continue to review requests for waiting time modification. The process of submitting the requests through the Organ Center will not change.   To evaluate the effectiveness of this policy, UNOS staff will assess the time from submission to Committee decision rendered for submitted requests.

Proposed Policy Language Changes Instead of one lengthy and circuitous page, the proposed policy is now broken into four distinct policy sections The requirements are now clearly stated in a bulleted list The application process is delineated in a numerical list Effectiveness of changes will be determined by evaluating: The number of incomplete requests submitted The length of time from submission to decision

Response to Public Comment Supported by all OPTN Regions Supported by Pancreas, Patient Affairs, and Transplant Coordinators Committees Supported with recommendations by Thoracic Organ Transplantation and Transplant Administrator Committees 87% support (13% no opinion) from general public

Waiting Time Modification Revisions The Board is asked to consider the following resolution: **RESOLVED that the modifications to Policy 3.2.1.8 (Waiting Time Modification) set forth below be implemented following notice to OPTN membership.

Remove NYFL Intended Candidate System from the Programming Queue

NYFL Alternative System NYFL has requested its intended candidate alternative system be removed from the programming queue The board is asked to consider the following resolution: **RESOLVED that the intended candidate variance for NYFL currently in the programming queue be removed as soon as is feasible as requested by NYFL.