Changes to Hospital-Based OPO (HOPO) Voting Privileges Membership & Professional Standards Committee

What problem will the proposal solve? Single vote to Hospital-Based OPOs (HOPO) and their corresponding transplant hospitals A HOPO may have different perspectives than the transplant hospital with which it shares a vote Change allows HOPO to independently vote on OPTN matters such as the Board of Directors election Notes: The OPTN Bylaws provide a single vote to the 7 Hospital-Based OPOs (HOPO) and their corresponding transplant hospitals. A HOPO may have different perspectives than the transplant hospital with which it shares a vote. Members believe that the current Bylaws voting provisions limit the representation of organ procurement interests in a HOPO DSA. The perception could be that the HOPO is under the control of the affiliated transplant hospital, potentially generating mistrust between the hospital-based OPO and other transplant hospitals within its DSA. If this proposal is approved, the HOPOs will be able to independently vote on OPTN matters such as the Board of Directors election. They could also vote independently on items such as public comment proposals at regional meeting. Granting HOPOs voting privileges will improve the efficiency of the OPTN ensuring that the perspectives of these members are better represented in OPTN voting matters.

What are the proposed solutions? An independent vote for qualifying HOPOs HOPO must document a level of separation from its hospital’s transplant program(s) HOPO administrative director is not in a leadership role within the transplant programs at the supporting transplant hospital. HOPO administrative director is not subordinate to the leadership in any transplant programs at the supporting transplant hospital If implemented, up to 7 existing HOPOs could qualify to vote Notes: The administrative director refers to positions including but not limited to the Executive Director, Chief Executive Officer or President of the OPO. The MPSC acknowledges that many OPO Medical Directors appropriately serve in a leadership role in a transplant hospital. There are presently 375 voting members in the OPTN.

X Reporting Structure Transplant Programs HOPO Hospital Leadership Explanation Transplant program administration should not be the same as or report to HOPO administration. Likewise, HOPO administration should not be the same as or report to Transplant Program leadership (such as the transplant administrator or chief of transplant surgery) The administrative director refers to positions including but not limited to the Executive Director, Chief Executive Officer or President of the OPO.

How will members implement this proposal? HOPOs may apply for a separate OPTN vote by submitting the following: A written request to UNOS staff Supporting documentation: Organizational charts for the supporting transplant hospital and the OPO Other documentation relevant to the OPO administrative director’s role. If a HOPO that has been granted separate voting privileges no longer meets the qualifications: It must notify UNOS in writing within 30 days of no longer meeting the qualifications and provide documentation of the reasons the qualifications are no longer met Notes: No other member organizations will need to take any action to implement this proposal. If an HOPO is seeking voting privileges it must submit a written request to the OPTN staff and provide documentation demonstrating that it meets these qualifications to receive voting privileges. This documentation should include organizational charts for the supporting transplant hospital and the OPO as well as any other documentation relevant to the OPO administrative director’s role. UNOS Member Quality staff will contact the HOPO’s about implementation. The request will be reviewed by the MPSC, and it will make a recommendation to the OPTN Board of Directors for approval or rejection of the OPO’s request for voting privileges. If a HOPO that has been granted separate voting privileges no longer meets the qualifications, then it must notify the OPTN staff in writing within 30 days of no longer meeting the qualifications and provide documentation of the reasons the qualifications are no longer met and the OPO will no longer have voting privileges. The OPO may reapply for voting privileges at any time that it meets the qualifications.

How will the OPTN implement this proposal? MPSC will review the request and recommend to the Board to approve or reject the HOPO’s request. Upon request, HOPOs may be asked to confirm that they still meet the requirements Notes: UNOS Member Quality staff will contact the HOPOs with the details about applying for voting privileges. The MPSC will review the HOPOs request and make a recommendation to the OPTN Board of Directors for approval or rejection of the request. HOPOs may be periodically asked to confirm that they still meet the requirements.

Questions? Notes: This proposal is focused solely on hospital-based OPOs and does not solicit feedback about the voting qualifications for any other member type. A separate project would need to be reviewed and approved by the Policy Oversight Committee and Executive Committee if changes were considered for other member types.