1. Vascularized Composite Allograft (VCA) Transplantation Committee
Align VCA Transplant Program Membership Requirements with Requirements of Other Solid Organ Transplant Programs
Vascularized Composite Allograft (VCA)
Transplantation Committee

2. What problem will the proposal solve?
VCA membership requirements will only allow board certified individuals to qualify for key personnel
Different standard for key personnel compared to solid organ transplant programs
In 2015, the Board of Directors approved amendments to the Bylaws to remove the option for solid organ transplant program key personnel to qualify based on foreign board certification. In lieu of accepting foreign board certification, a pathway was added for individuals who are not board certified in the U.S. or Canada to qualify for key personnel positions at solid organ transplant programs. This same pathway is not available for key personnel at VCA transplant programs. After September 1, 2018, only board certified individuals may qualify for key personnel positions at VCA transplant programs.
This absence of a mechanism for individuals who are not board certified in the U.S. or Canada creates different standards for key personnel at VCA transplant programs compared to solid organ transplant programs. While many leaders of VCA programs are board certified, some domestic and international VCA transplant programs are led by well-qualified and experienced individuals without board certification. The Committee feels these non-board certified individuals should be allowed to continue leading VCA programs, and have the opportunity to lead VCA programs in the future.

3. What are the proposed solutions?
Similar to all solid organ programs, to remove reference to foreign board certification
Similar to all solid organ programs, to add CME pathway for non-board certified individuals
The proposal intends to apply the changes made to the solid organ transplant programs requirements to the requirements to VCA transplant programs. This includes:
Remove the reference to foreign board certification
Add CME pathway for non-board certified individuals to qualify for key personnel at VCA transplant programs
I should emphasize, this proposal is intended to add a pathway for non-board certified individuals to qualify for key personnel positions at VCA transplant programs. This pathway includes requirements for continuing medical education (CME) and letters of reference from VCA program directors. These two requirements would be in addition to existing requirement for actual VCA case experience. This proposal is not intended to reduce in any way the rigor of the training and experience requirements for key personal at VCA transplant programs. The end-goal is that VCA programs are held to the same standard as their solid organ counterparts.

4. How will members implement this proposal?
Affected VCA transplant programs will be responsible for proposing individuals who qualify for key personnel positions
Small increase in data submitted on membership applications
Non-board certified individuals must adhere to CME pathway requirements identified in their application
MPSC will review VCA applications to determine compliance
If approved by the Board, transplant hospitals with approved VCA transplant programs must propose individuals who qualify for key personnel positions. There will be a small increase in the information submitted to the OPTN. Additional information will be required when a physician or surgeon completes a membership application. This will include submitting two letters of recommendation from VCA program directors not employed by the applying transplant hospital, and the applicants plan for continuing education. If individuals applying are non-board certified, they will be responsible for adhering to the requirements of the CME pathway identified in their application. The MPSC will review the VCA transplant program applications to determine compliance with these proposed amendments.

5. How will the OPTN implement this proposal?
Board consideration – June 2018
No programming in UNetSM
Programming required UNOS membership databases
Two phases of language changes
All VCA transplant programs required to re-apply upon notification by the OPTN
Phase
Bylaw Language Change
Date 1
Strike sunset provision for primary transplant surgeon of head and neck, and upper limb programs
September 1, 2018 2
Elements of CME pathway, amendments to Appendices D & J
No sooner than Q2 2019
The targeted date for Board consideration is the June 2018 meeting.
This proposal will not result in any programming change to Waitlist, DonorNet, or Tiedi. However, UNOS will need to program its internal membership databases to capture and manage the information entered on membership applications.
The Bylaw language changes in the proposal will require two phases. The first phase includes striking the sunset provision from the requirements for the primary VCA transplant surgeon for head and neck, and upper limb transplant programs. We need this to continue to allow these non-board certified individuals to qualify for key personnel positions at VCA transplant programs. This phase will be effective on September 1, The second phase includes elements of the CME pathway, and amendments to Appendices D and J for clarity. This second phase is targeted to be implemented no sooner than the second quarter of 2019.
The detailed training and experience requirements for key personnel at VCA transplant programs are substantively different from the 2014 requirements. As a result of these differences, all VCA transplant programs must re-apply. This application period no sooner than the forth quarter The OPTN will notify all VCA programs about the application period. Those currently approved VCA transplant programs who do not wish to reapply can submit an opt-out notice to the OPTN.
The VCA Committee will monitor aggregate data on approved personnel changes in the following situations:
Non-board certified individuals applying for key personnel positions at a VCA transplant program,
instances when a U.S. board ineligible individual applies and is declined for a key personnel position at a VCA transplant program,
and new VCA transplant programs applying with non-board certified individual applying for a key personnel positions at a VCA transplant program.

6. Requested feedback
Should “category-one” CME and “self-assessments” for VCA personnel be more specifically defined than all other transplant key personnel?
Should VCA key personnel using this pathway be required to have additional board certification compared to key personnel of other solid organ programs?
Should the primary transplant surgeon of a solid organ program be allowed to qualify as the primary VCA transplant surgeon?
The Committee encourages all interested individuals to comment on the proposal in its entirety. The Committee is requesting feedback on the following three items:
When considering the addition of a the CME pathway, the some Committee members felt select elements of the pathways were broad and this may lead to lack of clarity for OPTN members. Should “category-one” CME and “self-assessments” be more specifically defined?
The Committee discussed whether “foreign board certification” should be required in the membership requirements for VCA transplant programs in addition to the CME pathway established for all other organs. One argument was to ensure some additional level of advanced certification if a surgeon not be board certified in the U.S. or Canada. Other arguments were to continue to adhere to the precedent and experience for other transplant programs and to achieve alignment. Do you feel this is an appropriate approach, or would this inclusion have unintended impact (e.g.: potentially exclude well qualified surgeons from being considered)?
The membership requirements for the primary VCA transplant physician allow a solid organ primary transplant surgeon or physician to qualify. The rationale for this is that this solid organ transplant surgeon or physician may have the expertise to oversee the medical management of VCA candidates and recipients. Do you feel the language for the primary VCA transplant surgeon should include a similar allowance? Would such an allowance diminish the rigor of the training and experience requirements for the primary transplant surgeon of head and neck, or upper limb transplant program?

7. Questions? L. Scott Levin, M.D., FACS Committee Chair
Linda C. Cendales, M.D.
Committee Vice Chair
Christopher L. Wholley, M.S.A.
Committee Liaison