1. Adam Bingaman, MD, PhD Regional Councillor
Region 4 Meeting
Adam Bingaman, MD, PhD
Regional Councillor
Welcome to the spring Region 4 meeting. We know you took time out of your schedule to be here and your attendance is appreciated.

2. Meeting agenda Update from OPTN/UNOS leadership
Regional discussion session – New!
Living Donation
OPO Dashboard
System Optimization
Review and discuss 3 public comment proposals and 1 white paper
Your feedback will be shared with the Ethics, Kidney and Liver Committees
Updates on committee activities: Kidney, Liver, Transplant Coordinators
Today’s meeting includes
An update from OPTN/UNOS leadership
A regional discussion session
discuss and comment on proposed policies – your feedback will be shared with the sponsoring committees
Updates on committee activities

3. Regional Business Summary of fall 2016 regional meeting
Why should you review it?
Committee’s response to our region’s comments
Board’s action on each proposal
Information on implementation date
A summary of the fall regional meeting is located in the booklet at your seat and is posted to Transplant Pro for your review.
The summary provides information about the proposals that we discussed at the spring meeting, and where they stand now. The summary includes each committee’s response to our region’s comments, the Board action taken on each proposal, and information about implementation. Implementation dates are not available for proposals that require computer programming.

4. Fall regional meeting date
Fall public comment: July 31 – October 2, 2017
proposals will go to the Board for review in December
Fall 2017 region 4 meeting: August 25, 2017 in Dallas
Mark your calendar!
The regional meeting cycle runs concurrent with the public comment cycle. The fall 2017 public comment cycle will begin on July 31 and end September 29. The public comment proposals we discuss at the fall regional meeting will be reviewed by the Board in December.
The fall regional meeting will be held on August 25th in Dallas.

5. Region 4 Meeting Attendance
Our goal is to have every institution represented at every regional meeting. We were above the national average in the fall and welcome any suggestions for how to engage more members.

6. Regional Business Councillor responsibilities
Moderate regional meetings, oversee regional business
Serve as the region 4 representative to the OPTN/UNOS Board of Directors
Present the region’s feedback on public comment proposals and other OPTN/UNOS matters
To best represent the region, I need to hear from you
Welcome members of the Board of Directors
As regional councillor, I moderate regional meetings and oversee regional operations. Most importantly, I serve as the region 4 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. So, speak up today, and feel free to 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.
FYI – Stuart Sweet is the only Board member that I know of that will be attending.

7. OPTN/UNOS Committee Nominations
Nominations reviewed by regional nominating committee
Election ballot sent to regional voting members
Committee leadership is reviewing committee rosters, and finalizing for OPTN President-Elect review
Purpose: ensure staffing needs of the committees are met, and expertise needed for project work is represented
President-Elect reviews the membership of all committees
Purpose: goal is for the committee system to represent the community we serve - balance of professions, opinions, race, gender
New committee members will receive notice by early April
Thank you to everyone who submitted a nomination to serve as a region 4 representative on a committee. I met with our region’s nominating committee and we selected candidates for an election ballot based on:
-professional experience
-staffing needs of each committee
-diversity in profession and demographics
-past history of regional engagement
-past history of the candidate’s ability to represent both regional and national perspectives
-geographic balance in the region
The committee chairs are reviewing the rosters now to make sure each committee has the members it needs to do the work of the committee over the next year. OPTN President-Elect, Yolanda Becker, will review the committee rosters to make sure the committee system represents the community we serve and includes a balance of specialties, opinions, race and gender. Members appointed as regional representatives will receive notice by early April.
Committee terms for new regional representatives will begin July 1, 2017.
FYI – in case you need it, the nominating committee membership includes: the current Region 4 Councillor, Associate Councillor (Steve Potter), two individuals from Texas (Patti Niles and Muhammad Mujtaba), one individual from Oklahoma (Jeff Orlowski), and the Region 4 representatives to the Histocompatibility (Chantale Lacelle) and Thoracic Transplantation Committees (Mark Drazner).

8. OPTN/UNOS Committee Recommendations
Liver and Intestine Transplantation Committee – John Goss, MD
Minority Affairs Committee – Richard Ruiz, MD
Operations and Safety Committee – Ben Keebler, EMT-P
OPO Committee-Chad Ezzell, CPTC, CTP
Pancreas Transplantation Committee-Matthew Mulloy, MD
Pediatric Transplantation Committee-Tamir Miloh, MD
Thoracic Transplantation Committee – Shelley Hall, MD
Transplant Administrators Committee-Betsy Stein
Transplant Coordinators Committee- Christopher Schwatrz
Here is a list of new regional representatives elected in December.
Please keep in mind that these are recommendations from the region, and that final committee appointments are made by the incoming President of UNOS.

9. Committee Representation 2015-2016 vs. 2016-2017: Demographics
Last June, the OPTN Board formed 2 committees: one to review the structure of the committee system and make recommendations for improvement to leadership, and a second committee to develop a needs assessment and development plan for the Board of Directors and to review the Board’s structure. This slide shows the committee representation for the past 2 years in certain demographics: race and gender.

10. Our region’s nominations from the fall
This slide shows the demographics of nominations received from Region 4 this fall.

11. Some of the challenges with the current Committee structure
11 of 18 individuals on most Committees are selected by a group other than the committee and OPTN leadership
Lack of diversity (perspectives, demographics, professions) due to disjointed appointment process
Review all committee rosters to identify specialties and demographics that are underrepresented
Here are some of the challenges with the current committee structure:
- 60% of each committee’s membership is determined by groups other the committee leadership. The committees are identifying their staffing needs and the expertise they need for certain projects and the regions are considering these needs when reviewing nominations and making selections.
- There is a need for a group to oversee the entire appointment process to identify areas where the committee system is underrepresented in certain categories such as professions, perspectives, and demographics.

12. Regional Meeting Agenda: Discussion
Discussion agenda format is the same as previous meetings
3 public comment proposals and 1 white paper
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.

13. 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
There were requests to move the White Paper on Financial Incentives to discussion
The remaining proposals will be voted on today, but not presented or discussed
Proposals presented and discussed during national webinars
The proposals on the non-discussion (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 1 white paper, 1 proposal, and 1 guidance document that are anticipated to have a lower impact on the transplant community as a whole.
There were requests to move the white paper on Financial incentives to the discussion agenda. There were requests to move the white paper to the discussion agenda. An updated agenda is in your booklet.
The remaining proposals on the non-discussion agenda will be voted on today, but they will not be presented or discussed.

14. National Webinars
Two webinars to present and discuss the proposals and white paper on non-discussion agenda
Monday, February 27, 2:00-3:00 pm ET
Registration information located on Transplant Pro
One webinar was held in January and a second webinar (identical in content) will be held on February 27 to present summaries of the proposals and white papers. Members are given an opportunity to ask questions and provide feedback on the webinars. Registration information is located in the “region” section of the Transplant Pro website.

15. Non-Discussion Proposals: Vote You have the option to abstain from voting if you haven’t reviewed the proposals
Rewrite of Bylaws Article II: Board of Directors (Executive Committee)
Histocompatibility Testing Guidance Document (Histocompatibility Committee)
This slide includes a list of the proposals that we will vote on today. **Read the title of each proposal**
The plan is to take one vote on both 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 both: yes, no, abstentions
If hands are raised: vote on each proposal separately – yes, no, abstentions

16. 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 yellow 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.

17. Public Comment Opportunities
Contact Regional Representatives
List is located on Transplant Pro: select the community tab, and then “regions”
Submit public comment online
OPTN website:
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.

18. Regional Meeting Materials – online!
The presentations presented today are posted on Transplant Pro
Make sure to review the presentations that weren’t presented today
Histo, OPO, Pancreas, Patient Affairs, Pediatric, Transplant Administrators, Thoracic, 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 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.

19. Regional and National Data

20. Deceased Donation 2015-2016 U.S. Donors Recovered Organs Recovered
Donors Recovered
Organs Recovered
Organs Transplanted
OTPD
2015
9,079
31,917
27,540
3.033
2016
9,972
35,357
30,490
3.058
% Change
9.8%
10.8%
10.7%
0.80%

21. Deceased Donors by Type and Region 2016
Still a relatively small percentage of donors recovered in Region 3 are from DCD, while at least 20% of donors in Regions 1, 6, 7, 8, 9, and 10 are DCD donors. Regions 2, 3, 5, and 9 have the greatest percentages of ECDs with over 20.5%

22. Deceased Donation 2015-2016 Region 4
Donors Recovered
Organs Recovered
Organs Transplanted
OTPD
2015
944
3,295
2,912
3.085
2016
1,113
3,920
3,414
3.067
% Change
17.9%
19.0%
17.2%
-0.60%

23. Deceased Donors by Type 2007-2016 Region 4
44%

24. Deceased Donor Transplants 2014-2016 U.S.

25. Deceased Donor Transplants 2014-2016 Region 4

26. Framing the day We want feedback from as many attendees as possible
Please actively participate in the regional discussion session!
During the discussion of 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 for opposition and any modifications the committee could make

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