1 Region 7 Meeting Julie Heimbach, MD Regional Councillor

2 Purpose of Regional Meeting  Discuss regional business  Provide updates on OPTN/UNOS committee activities and projects  Discuss and comment on proposed policies and bylaws

 Summary of Spring and Fall 2015 regional meeting  Includes sponsoring committee’s response to regional comments  Board action on each proposal Regional Business 3

Improving the OPTN Policy Development Process  No change post public comment - Approved Proposal to Establish a Quality Assurance and Performance Improvement Requirement for Transplant Hospitals and Organ Procurement Organizations  Modified proposal to require a QA plan but all details removed – Approved Definition of a Transplant Hospital  Not submitted to the Board Proposal to Implement Pre-transplant Performance Review by the Membership and Professional Standards Committee  Not submitted to the Board June Board – Regional Comments 4

Proposal for the Definition of Pancreas Graft Failure  Modified post public comment to address concerns– Approved Proposed Changes to the OPTN Bylaws Governing Histocompatibility Laboratories  No modifications post public comment - Approved Policy Rewrite Parking Lot “Quick Fixes”  Final proposal did not include HCC modifications – Approved Proposal to Establish Pediatric Training and Experience Requirements in the Bylaws  Proposal submitted for reconsideration Fall 2015 Proposal to Require Re-Execution of the Match Run when a Deceased Donor’s Infectious Disease Results Impact Potential Recipients based upon Screening Preferences  Modified post public comment to address concerns - Approved 5

 Spring meeting date: February 18 th in Chicago  Spring public comment: January 25-March 25  Check Transplant Pro website for regional meeting date  Spring proposals will be reviewed by the OPTN/UNOS Board in June Regional Business 6

Regional Meeting Attendance Nationaly 7

 Deadline for regional representative nominations: October 15  Nomination announcement with link to online bio form is posted on the Transplant Pro website  Nominations reviewed by regional nominating committee  Regional recommendations considered by OPTN/UNOS President-Elect  Appointments in April for terms beginning July 1 OPTN/UNOS Committee Nominations 8

 Minority Affairs  OPO  Pancreas  Thoracic  Transplant Administrators OPTN/UNOS Committee Nominations 9

Institutional Participation in Committee Process 10

 Regional representative to the MPSC for a 2-year term ( )  Councillor position for additional 2 years  Moderate regional meetings  Represent the region on the Board of Directors  Election process  Call for nominations will be sent on 10/15– deadline October 30  Regional Guidelines – Nominee should be from Illinois  If needed the regional nominating committee develops the slate  Ballot sent to regional voting representatives Associate Councillor 11

 Serves a *2-year term on the Histocompatibility Committee  Call for nominations will be sent on October 15 to labs, deadline is October 30  Election: slate will include the 2 nominees who receive the most nominations, ballot sent to independent lab voting representatives Histocompatibility Committee Representative 12

Regional Data 13

 Overall waiting list additions increased for third year in a row  Slight decrease in both Kidney and Liver additions.  Heart additions saw most significant increase.  Total and active registrations at year end peaked again in 2014 Waiting List National Trends

Waiting List Registrations Region 7

Donor and Transplant Data

 Deceased donors increased by 4.0% (8,596 from 8,268), and increased donor transplants decreased by 2.4% from 2013  increases in DCD, SCD donors  DCD donors now comprise 15% of deceased donors overall (ranges from 7%-32% by region)  2.8% decrease in living donation from National Trends

Deceased Donation U.S. Donors Recovered Organs Recovered Organs Transplanted OTPD 20138,26829,40325, ,59630,16026, % Change4.00%2.60%2.40%-1.50%

Donors Recovered Organs Recovered Organs Transplanted OTPD ,2942, ,4642, % Change 4.40%7.40%5.50%1.00% Deceased Donation Region 7

Deceased and Living Donors U.S.

Deceased and Living Donors Region 7

Deceased Donors by Type U.S. 7%

Deceased Donors by Type Region 7 3%

Percent Change in Deceased Donors and Organs Recovered/Transplanted 2013 – Region 7

Region 7 Deceased Donors RecoveredDeceased Donor Organs Recovered Deceased Donor Organs TransplantedDeceased Donor OTPD

What should we be looking at??

30 UNOS Update Brian Shepard UNOS Executive Director Region 7

OPTN and UNOS Strategic Planning 31

2012 v Goals 32

Feedback from Regional Surveys 33

Re-Balancing Resource Allocation allocation of effort: Increase transplants 40% Provide equity30% Improve outcomes 15% Promote safety10% Promote efficiency5%

Committee Project Portfolio 35

Metrics and quality improvement 36

MPSC Outcomes workgroup 37

OPO evaluations 38

Member Quality Pilot 39

Real Life Lessons 40

OPTN/UNOS Finance Update 41

OPTN Revenue: Registrations 42

 The OPTN contract is funded with OPTN registration fees and federal appropriations  2016 OPTN budget is $49,497,000. $44,876,000 in OPTN fees for operations $ 3,500,000 in federal appropriations for operations $ 1,121,000 to OPTN fees for reserves  2015 OPTN budget was $48,313,000. $43,623,000 in OPTN fees for operations $ 3,000,000 in federal appropriations for operations $ 1,690,000 in OPTN fees for reserves OPTN Funding 43

 Combined OPTN and UNOS fees remain at $957.  OPTN fee increased $19, while UNOS fee declined $19.  $20 of each registration fee is dedicated to OPTN reserves.  $20 of each registration fee is dedicated to UNOS reserves. Fees 44

Projected Costs and Fees 45 FY 2015 FY 2016 FY 2017 FY 2018 Expenditures$46,622,786$48,376,211$49,370,410$50,826,810 Funding HRSA Federal Appropriations$3,000,000$3,500,000$4,000,000$4,500,000 Reg Funding Carryover from FY 14 (IT fees)2,100,000500,00000 Projected Registrations54,50056,06656,72757,197 Calculated OPTN Base Fee$762$792$800$810 OPTN Base Fee$762$792$800$810 OPTN Reserve Fee$31$20 Total OPTN Fee$793$812$820$830

UNOS IT update 46

2015 IT Releases Membership Screening for Kidney and Pancreas 2. Revise the Lung Allocation Score (LAS) 3. Pediatric Lung Other Specify Diagnosis 4. Require HLA C and DQB (First Increment) 5. Tiedi OMB Form Changes 6. Living Liver Donor Follow-up 7. Potential Derived Disease Transmission Reporting 8. Pediatric Liver – Remove ICU Requirements 9. Pediatric Liver – Revise Hepatoblastoma Requirements 10. Update HLA Equivalency Tables 11. Update HLA Equivalency Tables 12. Transnet Android National Deployment 13. Transnet Web OPO Functionality 14. Match Run Changes 15. HOPE ACT membership application (internal) 16. Comprehensive Histo Rewrite 17. Deceased Donor Updates 18. Transnet iPad (Beta release) 19. Infectious Disease 20. Transnet TxC Match/Receipt

2015 Board Project Plan Box Color Completed Underway non-BOD work Scheduled Text Color Projects Approved 2013 or prior Projects Approved 2014 Scheduled

 iPad  User Acceptance Testing (UAT) – July 2015  Production release – Q4  Mobile Phones (iPhone6 & 6-Plus, corresponding Android phones )  Start Development – August 2015  UAT– Late 2015/early 2016  Production release – Q  Transplant Center Functionality  Completed requirement gathering  Start development– June 2015  Beta test (3 centers)– August 2015

 Approved projects start prior to next Board meeting  No projects are ever older than 12 months Board Project Service Level Objective 50 Board Approval 50% of Projects Started 95% of Projects Started 90% of Projects Complete 100% of Projects Complete Time T=0T= 3 monthsT= 6 monthsT= 9 monthsT= 12 months

23 Projects 2 Delivered 3 in progress 18 in queue 18 older than 12 months 44+ Projects 29 delivered 2 in progress 13+ in queue 3 older than 12 months ? Projects 15+ delivered ? in progress ? in queue 0 older than 12 months IT Board Backlog by the End of… Projects 7 Delivered 5 in progress 23 in queue 16 older than 12 months

Regional Business Meeting 52

 Discussion agenda format is the same as previous meetings  8 public comment proposals  Presentation  Discussion  Regional Vote Regional Meeting Agenda: Discussion 53

 Includes 4 proposals anticipated to have a lower impact on the transplant community  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 Regional Meeting Agenda: Non- Discussion 54

 Proposed Changes to Transplant Program Key Personnel Procurement Requirements (Membership and Professional Standards Committee)  Revising Kidney Paired Donation Pilot Program Priority Points (Kidney Transplantation Committee)  Proposal to Update the Human Leukocyte Antigen (HLA) Equivalency Tables (Histocompatibility Committee)  Proposal to Reduce the Documentation Shipped with Organs (Organ Procurement Organization Committee) Non-Discussion Proposals: Vote You have the option to abstain from voting if you haven’t reviewed the proposals 55

 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 Proposals 56

 Contact Regional Representatives   Submit public comment online  OPTN website: comment/ comment/  blog-style format,  individual, regional, and committee comments are pubished Public Comment Opportunities 57

 The presentations shared today are posted online:   Make sure to review the presentations that weren’t presented today  Additional information available on this website including:  Meeting agenda and summaries  Data  Links to various OPTN resources Regional Meeting Materials – online! 58

Questions? 59