1. National Webinar to Review Non-Discussion Agenda
Fall 2016 Public Comment
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Good Afternoon, this is XXXX, and on behalf of the Regional Administration department I would like to thank you for joining the webinar today. If you are logged into the online portion of the webinar, please remember to enter your audio PIN which appears on the right hand side of your computer screen just beneath the phone number. In addition, please put your phone on MUTE and do not put the call on HOLD.

2. Webinar Objectives Review non-discussion agenda process
Present and discuss proposals on the non-discussion agenda
Review methods to submit feedback to sponsoring committees
Here are the objectives for today’s call.
We will review the non-discussion agenda process, present proposals and white papers on the non-discussion agenda and have a question and answer period following each presentation. We will also review ways to submit feedback on public comment proposals and white papers.

3. Regional Meeting Goals
Discuss proposed policies and bylaws
Collect feedback and provide to sponsoring committees
Advisory to the councillor during Board deliberations
Executive update on OPTN/UNOS activities
Receive updates on OPTN committee activities and projects
Discuss regional business
The primary function of regional meetings is to provide an opportunity for members to discuss proposed policy and bylaw changes. The feedback received during the meetings is provided to OPTN committees and to the regional councillor for consideration during discussions at the Board of Directors meeting.
Members in attendance at regional meetings also receive information about current OPTN and UNOS activities presented by UNOS Executive staff and are updated about new and ongoing committee activities by regional representatives.

4. Regional Meeting Agenda
Discussion Agenda
10 proposals presented, discussed, and voted on during meeting
Non-Discussion Agenda
2 proposals and 3 white papers presented today
No discussion at the regional meeting
Regional Vote
Process for moving a proposal to the Discussion Agenda
15% of member institutions within a region submit a request
All requests must be received one week prior to the regional meeting date
If the 15% threshold is met, proposal will be presented and discussed during regional meeting
Last week, 15 proposals were distributed for public comment.
The ten proposals placed on the regional meeting discussion agenda will be presented, discussed, and voted on during the regional meeting.
The remaining two proposals and three white papers are on the non-discussion section of the agenda. The proposals on the non-discussion agenda will not be presented or discussed at the regional meeting, but a vote will be taken on each to provide guidance to the regional councillor during discussions at the Board meeting.
The regions have the option to move a non-discussion proposal to the discussion section of the agenda. To do this, 15% of member institutions within a region must request that a particular proposal be moved to the discussion section. All requests must be submitted to your regional administrator at least one week prior to the regional meeting date. If the 15% threshold is met, the proposal will be presented and discussed in the applicable region.
Please keep in mind as you consider making a request that this process was put in place to ensure there is adequate time to discuss proposals and committee activities that are anticipated to have a larger community impact.

5. Non-Discussion Agenda Proposals
Consider Primary Transplant Surgeon Requirement – Primary or First Assistant on Transplant Cases (Membership and Professional Standards Committee)
Updating Primary Kidney Transplant Physician Requirements (Membership and Professional Standards Committee)
Split Versus Whole Liver Transplantation (Ethics Committee)
The Ethics of Deceased Organ Recovery without Requirements for Explicit Consent or Authorization (Ethics Committee)
Ethical considerations of Imminent Death Donation (Ethics Committee)
The 2 proposals and 3 white papers that appear on the Non-Discussion Agenda are listed here and will be presented today by committee members. After each presentation, there will be an opportunity to ask questions.
The first two proposals from the Membership and Professional Standards Committee will be presented by Dr. Patrick Northup, an at-large member of the committee.

6. Membership and Professional Standards Committee
Consider Primary Transplant Surgeon Requirement- Primary or First Assistant on Transplant Cases
Membership and Professional Standards Committee

7. What problem will the proposal solve?
Primary transplant surgeons for abdominal organs must have performed a set number of transplants and procurements as the “primary surgeon or first assistant”
No specification about the number of cases performed as the primary surgeon
Concerns that abdominal surgeons could qualify with only “first assistant” experience
Responsibilities of a surgical first assistant vary across institutions
May have never performed critical surgical transplant functions expected of a primary transplant surgeon
OPTN Bylaws require that primary surgeons at kidney, liver, and pancreas programs must have performed a set number of transplants and procurements as the “primary surgeon or first assistant.” Because there is no specification regarding the number of cases performed as the primary surgeons, concerns have been raised that applicants could qualify with only “first assistant” experience. Because surgical first assistant responsibilities vary across institutions, there are concerns that a primary transplant surgeon could be approved that may never have performed the critical surgical transplant functions that would be expected of a primary transplant surgeon leading a designated program.

8. What are the proposed solutions?
Training Pathways
Fellowship program accepts a case towards completion of training = OPTN accepts the case towards key personnel requirements in Bylaws
Abdominal and thoracic primary surgeons
Clinical Experience Pathways
At least 50% of the cases cited in an application must have been performed as the primary surgeon or co-surgeon
Applies to primary kidney, liver, and pancreas transplant surgeons
Bylaws already require a set number of primary surgeon cases for thoracic primary surgeons; this proposal does not impact those requirements
To address these problems, the MPSC is recommending one approach for the primary surgeon training pathways in the Bylaws and another approach for the clinical experience pathways. For all training pathways in the Bylaws, both abdominal and thoracic programs, if a transplant or procurement is counted towards the completion of fellowship or residency training then that case will also count towards the key personnel requirements in OPTN Bylaws. To validate these training experiences, primary transplant surgeon applicants applying through one of the fellowship or residency pathways will be required to provide a copy of the operative log from their training.
For the clinical experience pathways, the MPSC recommends adding a new requirement that at least 50% of the cases cited on a primary transplant surgeon application must have been performed as the primary surgeon. This new requirement only applies to the primary kidney, liver, and pancreas transplant surgeon clinical experience pathways as the Bylaws already require thoracic primary surgeons to have completed a set number of cases as primary surgeon. This proposal does not impact those Bylaws as they have not prompted any known issues.

9. Supporting Evidence
Proposal stems directly from recommendations developed by a Joint Societies Working Group (JSWG)
Collaborative effort between the American Society of Transplantation (AST), the American Society of Transplant Surgeons (ASTS), the North American Transplant Coordinators Organization (NATCO), and the MPSC
Training Pathways
Fellows are always noted as an assisting surgeon on hospital billing records
OPTN Bylaws training pathways for primary transplant surgeons already rely on quality training and experience gained during fellowship or residency
Clinical Experience Pathways
Qualifying without some primary surgeon transplant and procurement experience is unreasonable
JSWG agreed that at least half of cases cited should have been performed as primary surgeon
MPSC indicated “co-surgeons” are common in abdominal transplants, and such cases should be viewed as equivalent to cases performed as primary surgeon
The recommendations included in this proposal were discussed by a Joint Societies Working Group, and are representative of a collaborative effort between AST, ASTS, NATCO, and the MPSC.
Regarding the proposed changes to the fellowship pathways, discussion of this topic highlighted that fellows are always noted as an assisting surgeon on hospital billing records. Because of this, and considering that the OPTN Bylaws training pathways already rely on quality training and experience gained during fellowship or residency, the MPSC agreed with the Joint Societies Working Group that the best and easiest solution would be to allow all experience that counts towards the completion of one’s transplant training to count towards OPTN primary transplant surgeon requirements.
Regarding the clinical experience pathways, the Joint Societies Working Group agreed that it would be unreasonable for a primary abdominal transplant surgeon to qualify with only first assistant cases. To address this, the Joint Societies Work Group and the MPSC agreed that performing half of the required cases as the primary surgeon was a reasonable threshold. When the MPSC discussed the Joint Societies Working Group recommendations, they also indicated that “co-surgeons” are common in abdominal surgeries, and such experience should be viewed as equivalent to cases performed as the primary surgeon.

10. How will members implement this proposal?
No immediate action required of members
Membership applications received on or after the implementation date will be evaluated in consideration of these new requirements
Primary surgeon applicants applying through a training pathway must provide a copy of their fellowship or residency operative log.
Kidney, liver, and pancreas primary surgeon applicants applying through clinical experience pathways must have performed at least 50% of cases as primary surgeon or co-surgeon.
No action will be required of members upon the implementation of these proposed changes. These proposed change will not impact current primary transplant surgeons physicians; only membership applications received by UNOS on or after the implementation date will be evaluated in consideration of these new requirements. At this time, primary transplant surgeons applying through a training pathway will also be required to provide a copy of their fellowship or residency operative log.
For kidney, liver, and pancreas primary surgeon applicants applying through a clinical experience pathway, at least 50% of the reported cases must have been performed as the primary surgeon.

11. How will the OPTN implement this proposal?
Board consideration- December 2016
Programming – No
Federal government must approve updates to membership application forms
Implementation- MPSC will evaluate membership applications in consideration of these new requirements
Transition- changes do not impact current primary surgeons
New requirements will be used to evaluate applications received on or after the implementation date
If public comment is favorable, this proposal is slated to be considered by the OPTN/UNOS Board of Directors during its December 2016 meeting. Assuming the Board adopts these changes, they would be effective pending federal government approval of updates to the membership application and notice to the membership. No programming is necessary to implement these changes.
There is no monitoring associated with these proposed changes. After implementation, primary transplant surgeon applicants that do not meet these new requirements will not be approved.
So all are clear, let me reiterate that this new requirement does not impact current primary transplant surgeons. These new requirements will be used to evaluate primary transplant surgeon applications received on or after the to-be-determined implementation date.

12. Specific topics for feedback
Should the recommendations in this proposal also apply to the primary intestine surgeon Bylaws requirements approved by the OPTN/UNOS Board of Directors in June 2015 that are pending implementation?
Should the recommendations in this proposal also apply to the surgeon requirements of the pediatric component Bylaws approved by the OPTN/UNOS Board of Directors in December 2015 that are pending implementation?
The MPSC is particularly interested in the community’s perspective on whether these changes are appropriate to apply to Bylaws that were recently approved by the Board and are pending implementation- primary intestine transplant surgeon requirements and the pediatric component Bylaws. Because previous public comment discussions about these Bylaws included concerns about the ability to meet the case volumes required by each proposal, the MPSC was hesitant to apply additional requirements without more feedback from the community.

13. Questions – click hand button
To ask a question, click on the hand feature on the right hand side of your computer screen. We will unmute your phone line and call your name. Please remember to “un-mute” your phone as well.

14. Questions? Committee Chair Jeffrey Orlowski, MS, CPTC
Committee Liaison
Sally Aungier
Region 1 Rep
Stefan Tullius, MD, PhD
Region 2 Rep
Matthew Cooper, MD
Region 3 Rep
Christopher Anderson, MD
Region 4 Rep
Steven Potter, MD
Region 5 Rep
Kunam Reddy, MD
Region 6 Rep
Susan Orloff, MD
Region 7 Rep
Hoonbae Jeon, MD, PhD
Region 8 Rep
Timothy Schmitt, MD, FACS
Region 9 Rep
Rob Kochik, CPTC
Region 10 Rep
Todd Pesavento, MD
Region 11 Rep
Kenneth Brayman, MD, PhD
While we wait for questions, on the screen is a list of committee leadership and regional representatives on the MPSC.

15. Updating Primary Kidney Transplant Physician Requirements
Membership and Professional Standards Committee

16. What problem will the proposal solve?
Fellowship training requirements have been foundation for key personnel requirements in Bylaws
Requirements in the Bylaws have not evolved with nephrology fellowship training requirements
Physicians completing transplant nephrology fellowship through “alternative pathway” can’t qualify through the OPTN’s primary kidney transplant physician fellowship pathway
Fellowship training requirements have generally served as the foundation for key personnel requirements in OPTN Bylaws; however, primary transplant kidney physician pathways do not reflect some options and standards currently associated with transplant nephrology fellowships. For example, because the transplant nephrology fellowship pathway in the Bylaws specifies “12 months,” a primary transplant physician applicant who completed what is described as an “alternative pathway” fellowship would not currently qualify as a primary kidney transplant physician through the OPTN Bylaws’ kidney physician fellowship pathway.

17. What are the proposed solutions?
Add language to accommodate the transplant nephrology fellowship “alternative pathway”
New patient case volume requirements
Evaluate 25 potential kidney transplant recipients
Evaluate 10 potential living kidney donors
Minor Bylaws modifications for additional clarity
To update the OPTN Bylaws to align with current transplant nephrology fellowship requirements, the MPSC recommends adding language to accommodate the transplant nephrology fellowship “alternative pathway,”
adjusting the patient evaluation requirements (25 potential kidney recipients; 10 potential living donors),
and other minor clarifications to these Bylaws.

18. Supporting Evidence
Proposal stems from a Joint Societies Working Group (JSWG) recommendation
Collaborative effort between AST, ASTS, NATCO, and the MPSC
Fellowship training requirements have been foundation for key personnel requirements in Bylaws
Critical requirements to complete a transplant nephrology fellowship have not been incorporated in Bylaws
A Joint Societies Working Group made up of professionals from the American Society of Transplantation, the American Society of Transplant Surgeons, the North American Transplant Coordinators Association, and the Membership and Professional Standards Committee made the recommendations for this proposal.
Fellowship training requirements have historically served as the foundation for key personnel requirements in Bylaws, and critical requirements to complete a transplant nephrology fellowship have not been incorporated in Bylaws. To remedy this, the joint working group referenced the Transplant Nephrology Fellowship Training Accreditation Program’s current fellowship requirements to update the OPTN Bylaws regarding primary kidney transplant physician requirements.

19. How will members implement this proposal?
No immediate action required of members
Membership applications received on or after the implementation date will be evaluated according to new requirements
In addition to current requirements, primary kidney transplant physician applicants must have been directly involved in evaluating:
25 potential kidney recipients
10 potential living kidney donors
No action will be required of members when these proposed changes are implemented. These proposed changes will not impact current primary kidney transplant physicians. The changes would impact how membership applications are reviewed AFTER implementation. At that time, primary kidney transplant physician applicants will be required to have been directly involved in the evaluation of 25 potential kidney recipients and 10 potential living kidney donors.

20. How will the OPTN implement this proposal?
Board consideration- Dec. 2016
Programming – No
Federal government must approve updates to membership application forms
Implementation- MPSC will evaluate membership applications based on new requirements
Monitoring- none
Transition- changes do not impact current primary kidney physicians
New requirements used to evaluate applications received on or after the implementation date
If public comment is favorable, this proposal is slated to be considered by the OPTN/UNOS Board of Directors during its December 2016 meeting. Assuming the Board approves these changes, they would be effective after the federal government approves updates to the membership application and members have been notified. No programming is necessary to implement these changes.
There is no monitoring associated with these proposed changes. Once the change is implemented, primary kidney transplant physician applicants that do not meet the new requirements will not be approved.
To be clear, let me reiterate that these new requirements do not impact current primary kidney transplant physicians. Only the primary kidney transplant physician applications received on or after the to-be-determined implementation date will be evaluated based on the new requirements.

21. Questions – click hand button
To ask a question, click on the hand feature on the right hand side of your computer screen. We will unmute your phone line and call your name. Please remember to “un-mute” your phone as well.

22. Questions? Committee Chair Jeffrey Orlowski, MS, CPTC
Committee Liaison
Sally Aungier
Region 1 Rep
Stefan Tullius, MD, PhD
Region 2 Rep
Matthew Cooper, MD
Region 3 Rep
Christopher Anderson, MD
Region 4 Rep
Steven Potter, MD
Region 5 Rep
Kunam Reddy, MD
Region 6 Rep
Susan Orloff, MD
Region 7 Rep
Hoonbae Jeon, MD, PhD
Region 8 Rep
Timothy Schmitt, MD, FACS
Region 9 Rep
Rob Kochik, CPTC
Region 10 Rep
Todd Pesavento, MD
Region 11 Rep
Kenneth Brayman, MD, PhD
While we wait for questions, on the screen is a list of committee leadership and regional representatives on the MPSC.

23. White Paper: Split Versus Whole Liver Transplantation
Ethics Committee
The next three white papers will be presented by the Chair of the Ethics committee, Dr. Peter Reese.

24. What is this resource? Revised white paper from the Ethics Committee
Committee had been tasked with updating a prior version written many years earlier
Provides an ethical analysis and recommendations regarding split-liver transplantation
Target Audience:
Transplant hospitals or OPOs considering split liver transplantation
Candidates who may be evaluating split-liver transplantation versus whole-liver transplantation
Beginning in 1993, the Ethics Committee (the Committee) developed a series of white papers that are available through the OPTN website. The purpose of the white papers is to provide guidance and to stimulate discussion around important subjects.
In 2014, the Committee began a systematic review of these white papers to evaluate if each of the white papers were accurate and relevant, and therefore valuable resources for the transplant community. The original white paper addressing split liver allocation was determined to require revision it contained outdated terminology, and other information that was not accurate.

25. Changes to the white paper
Committee completed a substantive revision of this white paper addressing:
Ethics of optimal allocation
Current allocation of deceased donor allografts
Splitting a deceased donor allograft
Ethics of modifying allocation and practice to promote split liver transplantation
Informed consent
Center expertise
Additional challenges
Over the past year, the Committee completed a substantive revision of the white paper addressing split liver allocation which includes recommendations for changes to the liver allocation, an extensive set of citations, new appendices, and new illustrations.
The topics addressed in this white paper include the those items displayed on the screen.

26. How will members access this resource?
Members will be able to access this resource through the OPTN website
Current white papers are available under the Resources tab, select Ethics

27. Supporting Evidence January 1, 1995 – December 31, 2015
Total Deceased Donor Liver Transplants
113,394
Total Split Liver Transplants
1546
1.36%
Split Liver Allograft Transplants to Pediatric Recipients
1439
93%
Whole Liver Transplants to Pediatric Recipients
107
6.8%
The following slides are not expected to be presented during the regional meeting, but provide evidence if needed to address questions.
[I’m going to give you a few minutes to review this table.
As you can see the total number of split liver transplant per year is low and most split liver transplant benefit pediatric recipients

28. Supporting Evidence
New split liver criteria were adopted in November 2006.
From 19 months pre-adoption through 19 months post-adoption (April 2004–June 2009)
2,247 (10.3%) of 21,832 deceased donors met the criteria;
218 (1.1%) of 19,644 livers transplanted were split-liver transplants.
The split liver criteria were adopted in Nov. 2006; from

29. Supporting Evidence
From June 1, 2001 through Dec. 31, 2015, 129,276 (85%) of 151,250 adult registrations for liver transplantation noted a willingness to accept a split liver at listing
In 2015, 10,100 (90%) of 11,256 adult registrants for liver transplantation noted a willingness to accept a split liver at listing
From June 1, 2001 through Dec. 31, 2015, there were 151,250 adult registrations for liver transplantation; at listing, 129,276 (85%) noted a willingness to accept a split liver
In 2015, 10,100 (90%) of 11,256 registrants noted a willingness to accept a split liver.

30. Questions – click hand button
To ask a question, click on the hand feature on the right hand side of your computer screen. We will unmute your phone line and call your name. Please remember to “un-mute” your phone as well.

31. Questions? Committee Chair Peter Reese, MD, MSCE
Committee Liaison
Lee Bolton
Region 1 Rep
Amir Qamar, MD
Region 2 Rep
Jennifer Steel, PhD
Region 3 Rep
Danielle Cornell, RN, BSN, CPTC
Region 4 Rep
Courtenay Bruce, JD, MA
Region 5 Rep
Dorothy Rocha, MSW/LCSW
Region 6 Rep
Stephen Rayhill, MD, FACS
Region 7 Rep
Nicholas Hillman, RN, BSN
Region 8 Rep
Scott Westphal
Region 9 Rep
Bruce Gelb, MD
Region 10 Rep
Laura Murdock-Stillion, MHA, FACHE
Region 11 Rep
Jon Carrier, BS
While we wait for questions, on the screen is a list of committee leadership and regional representatives on the Ethics Committee.

32. White Paper: Ethics of Deceased Donor Organ Recovery without Requirement for Explicit Consent or Authorization
Ethics Committee

33. What is this resource? Revised white paper from the Ethics Committee
Original white paper addressing presumed consent was written in 1993 and is no longer accurate or relevant
Provides an ethical analysis and recommendations regarding deceased donor organ recovery without a requirement for explicit consent or authorization
Target Audience:
Transplant hospitals or OPOs considering deceased donor organ recovery without requirement for explicit consent or authorization
Beginning in 1993, the Ethics Committee (the Committee) developed a series of white papers that are available through the OPTN website. In 2014, the Committee began systematically reviewing these white papers to evaluate if each were accurate and relevant, and therefore valuable resources for the transplant community. The original white paper addressing presumed consent was produced in 1993, and was in response to proposed presumed consent legislation under consideration in Maryland and Pennsylvania.
Of note, the white paper was written soon after the advent of the web in 1990 and when there was limited access to personal computers. The original white paper proposed using mail to object to presumed consent, and cited Gallop surveys from 1985 and research from 1976.
Since this white paper was no longer accurate nor relevant, the committee completed a line-by-line review and a substantive revision. The revision includes a new title, and content addressing current issues with presumed consent. The additions are supported by citations to current research and literature.
The resource provides an ethical analysis of deceased organ recovery without requirements for explicit consent or authorization. This resource will assist families or surrogates of potential donors, organ procurement organizations and donor hospitals

34. Changes to the white paper
Extensive ethical analysis
Addresses different donation models
Provides arguments both for and against organ and tissue recoveries that do not require explicit consent or authorization
Addresses social media and networking
Addresses DCD
This white paper:
describes models of deceased organ and tissue recovery with and without explicit consent or authorization by the individual or surrogate decision makers
Analyzes the relative merits and weaknesses of each model in the context of deceased organ and tissue recovery
Explains why shifting to a model of deceased organ and tissue recovery without explicit consent or authorization in the US is not justified
Describes other approaches to increase the number of organs and tissues available for transplant

35. How will members access this resource?
Access this resource through the OPTN website
Current white papers available under the Resources > Ethics

36. Questions – click hand button
To ask a question, click on the hand feature on the right hand side of your computer screen. We will unmute your phone line and call your name. Please remember to “un-mute” your phone as well.

37. Questions? Committee Chair Peter Reese, MD, MSCE
Committee Liaison
Lee Bolton
Region 1 Rep
Amir Qamar, MD
Region 2 Rep
Jennifer Steel, PhD
Region 3 Rep
Danielle Cornell, RN, BSN, CPTC
Region 4 Rep
Courtenay Bruce, JD, MA
Region 5 Rep
Dorothy Rocha, MSW/LCSW
Region 6 Rep
Stephen Rayhill, MD, FACS
Region 7 Rep
Nicholas Hillman, RN, BSN
Region 8 Rep
Scott Westphal
Region 9 Rep
Bruce Gelb, MD
Region 10 Rep
Laura Murdock-Stillion, MHA, FACHE
Region 11 Rep
Jon Carrier, BS
While we wait for questions, on the screen is a list of committee leadership and regional representatives on the Ethics Committee.

38. White Paper: Ethical Considerations of Imminent Death Donation
Ethics Committee

39. What is this resource? New white paper from the Ethics Committee
Provides an ethical analysis of imminent death donation (IDD)
Target audience:
Transplant hospitals or OPOs counseling families or surrogates of potential donors
Specifically those who want an option for donation when the potential donor does not meet brain death criteria and is not a DCD candidate
In 2014, the a inter-committee workgroup lead by the Ethics Committee began an ethical analysis of imminent death donation. The work group included members of the OPO, Living Donor and Operations and Safety Committee.
The Committee developed the white paper for IDD to provide guidance to transplant hospitals or OPOs that may be counseling families or surrogates of potential donors, particularly those families/surrogates who want an option for donation when the potential donor does not meet brain death criteria and the potential donor is not a candidate for DCD.

40. What is Imminent Death Donation (IDD)?
IDD is a term that has been used for organ recovery from a live donor before withdrawal of ventilator support expected to result in the patient’s death. IDD applies to at least 2 types of potential donors:
An individual with devastating neurologic injury that is considered irreversible and who is not brain dead.
A patient who has capacity for medical-decision making, is dependent on life-support, has decided not to accept further life support who wants to donate
IDD is a term that has been used for the recovery of a living donor organ immediately prior to an impending and planned withdrawal of ventilator support expected to result in the patient’s death. IDD applies two at least two types of potential donors.
IDD might be applicable to an individual with devastating neurologic injury that is considered irreversible and who is not brain dead. Under this scenario, a surrogate would need to provide consent for living donation.
IDD might also be applied to a patient who has capacity for medical-decision making, is dependent on life-support, has decided not to accept further life support and indicates the desire to donate organs prior to foregoing life support and death. This type of potential donor could provided informed consent, and would not be prohibited under current policy.

41. Background and Results of Ethical Analysis
The Committee analyzed if IDD, compared to existing practices of attempting donation after cardiac death (DCD) could:
Honor the preferences of the potential
Support the preferences of the potential donor’s family or surrogate
Increase the number of potential organ donors
Increase the quality of organs donated for transplantation
The work group’s motivations were to analyze whether, compared to existing practices of attempting donation after cardiac death (DCD), the IDD could:
honor the preferences of the potential donor (if known, concerning organ donation or the potential donor’s end-of-life care);
support the preferences of the potential donor’s family or surrogate;
increase the number of potential organ donors
increase the quality of organs donated for transplantation

42. Background and Results of Ethical Analysis
The Committee determined:
IDD may be ethically appropriate and justified by the potential benefits to donors, donor families and recipients
Lack of data makes it impossible to conclude if IDD would increase the number of organs available for transplant
IDD has the potential to erode public trust in organ donation
The work group concluded that there could be circumstances where LD-PPW may be ethically appropriate and justified by the potential benefits to donors, donor families and recipients
The work group ultimately determined that at this time the lack of data makes it impossible to conclude whether the net number of transplants might decline or increase if LD-PPW were widely adopted.
The work group recognized that the controversy regarding IDD has the potential to erode public trust in donation in general. There could be a misperception that families will be under undue pressure to donate organs prior to the patient’s death and withdraw ventilator support in circumstances where a patient would otherwise recover.

43. Final Recommendations
The OPTN should not pursue IDD (at this time) due to its potential risks, the lack of community support and substantial challenges to implementation.
In the future, it may be possible to adequately address those challenges through additional research, careful policy development or revision.
Consequently, the Ethics Committee is recommending that that the OPTN discontinue work on IDD at this time, due to its potential risks, the lack of community support and substantial challenges to implementation.
In the future, it may be possible to adequately address those challenges through additional research, careful policy development or revision.

44. How will members access this resource?
Members will be able to access this resource through the OPTN website
Current white papers are available under the Resources tab, select Ethics

45. Questions – click hand button
To ask a question, click on the hand feature on the right hand side of your computer screen. We will unmute your phone line and call your name. Please remember to “un-mute” your phone as well.

46. Questions? Committee Chair Peter Reese, MD, MSCE
Committee Liaison
Lee Bolton
Region 1 Rep
Amir Qamar, MD
Region 2 Rep
Jennifer Steel, PhD
Region 3 Rep
Danielle Cornell, RN, BSN, CPTC
Region 4 Rep
Courtenay Bruce, JD, MA
Region 5 Rep
Dorothy Rocha, MSW/LCSW
Region 6 Rep
Stephen Rayhill, MD, FACS
Region 7 Rep
Nicholas Hillman, RN, BSN
Region 8 Rep
Scott Westphal
Region 9 Rep
Bruce Gelb, MD
Region 10 Rep
Laura Murdock-Stillion, MHA, FACHE
Region 11 Rep
Jon Carrier, BS
While we wait for questions, on the screen is a list of committee leadership and regional representatives on the Ethics Committee.

47. Fall 2016 Public Comment Opened August 15th Closes October 15th
Proposals are posted on the OPTN website under “Governance” tab

48. Providing Feedback Submit comments on the OPTN website
Communicate with your regional representative
To submit feedback on public comment proposals, please visit the OPTN website at the link that appears on the screen. To encourage public participation and transparency, the public comment site publishes submitted comments. In addition to posting a comment, you can also contact your regional representative to the sponsoring committee.

49. Regional Meeting Information
Regional meeting dates, locations, and meeting materials are located under the “community” tab of the Transplant Pro website.

50. Regional Administrators Contacts
Phone Number
3,9,10
Shannon Edwards
2,4,6,8
Betsy Gans
1,5,7,11
John Archer
We would like to thank you for joining us today and hope to see you at the regional meeting to discuss the remaining ten public comment proposals. If you have any questions about the regional meeting or today’s webinar, please contact your regional administrator. Contact information is listed on the slide on your screen.