Vascularized Composite Allograft (VCA) Transplantation Committee Spring 2019

Recently Implemented Projects Proposal Board Approval Implementation Date Guidance to OPOs on Optimizing VCA Authorization & Recovery Share effective practices for VCA authorization & recovery June 2018 June 12, 2018 A guidance document to help OPOs optimize VCA authorization and recovery was approved by the OPTN Board in June 2018. This resource is available on the OPTN website.

Upcoming Policy Implementations Proposal Board Approval Implementation Date Membership Requirements for VCA Transplant Programs Established minimum training and experience requirements for key personnel June 2015 Application period target Q2 2019 List Covered Body Parts Pertaining to VCA Added 8 covered body parts (OPTN Policy 1.2) Made training and experience requirements for primary transplant surgeons of head, neck and upper limb transplant programs consistent Non-substantive changes to Bylaws, Appendix J for style, consistency, and clarity June 2016 The Board approved the detailed training and experience requirements for key personnel at VCA transplant programs in June 2015. They approved a subsequent proposal clarifying what body parts were considered VCAs in June 2016. UNOS staff will be contacting VCA transplant programs as the application process nears. The target for this application period is Q2 2019.

Upcoming Policy Implementations Proposal Board Approval Implementation Date Aligning VCA Membership Requirements with Requirements for Other Transplant Programs Achieve greater alignment between VCA membership requirements and solid organ transplant requirements June 2018 Application period target Q2 2019 One new proposals was approved by the Board in June 2018: Modifications to the VCA membership requirements for greater alignment with other organ program requirements will be implemented in tandem with membership proposals on the prior slide; the target for this application period is Q2 2019.

Future Projects & Initiatives Proposal Status Understanding VCA Transplant Outcomes Modify recipient data collection to have better understanding of VCA transplant outcomes Ongoing discussions Public comment target – January 2020 Collaboration with AOPO Increase deceased donors screened for VCA donation Ongoing through 2019 The VCA Data Subcommittee is having on-going discussions on a proposal to collect wider amounts of information on VCA transplant recipients. The goal of this project is to have a better understanding of VCA functional outcomes to guide future policy-making decisions. A target for public comment on this proposal is January 2020. AOPO has committed to working with their partner organizations to increase the number of donors screened for possible VCA donation. Committee members are collaborating with AOPO on this initiative.

Approved VCA Transplant Programs* as of 1/18/2019 VCA Program Type Number Abdominal Wall 15 Head and Neck 17 Upper Limb 19 Other VCA Genitourinary – Uterus 5 Genitourinary – Penis 2 Genitourinary/Urogenital 3 Lower Limb Musculoskeletal Composite Graft Segment 1 Total 64 *Representing 28 transplant hospitals Based on most recent available information provided by members to the OPTN as of January 18, 2019. Data subject to change based on future data submission or correction.

VCA Waiting List and Transplant Numbers by Type as of 1/18/19 VCA Type Candidates Added to Waiting List, 7/3/2014-1/18/19 Transplants, 7/3/2014-1/18/19 Candidates Waiting as of 1/18/19 Abdominal Wall 7 2 Head & Neck: Craniofacial 11 6 4 Head & Neck: Scalp 1 Upper Limb, Bilateral 12 3 Upper Limb, Unilateral 10 Other: GU - Penis Other: GU - Uterus 30 17 Total 75 39 24 Based on most recent available information provided by members to the OPTN as of January 18, 2019. Data subject to change based on future data submission or correction.

Questions Linda C. Cendales, M.D. Chair linda.cendales@duke.edu Bohdan Pomahac, M.D. Vice Chair bpomahac@partners.org Christopher L. Wholley, M.S.A. Transplant Community Administrator christopher.wholley@unos.org