1. Liver and Intestinal Organ Transplantation Committee Update Report
David Mulligan, MD, Chair
OPTN/UNOS Board of Directors Meeting
November 12-13, 2014

2. Develop Materials to Educate Liver Regional Review Board Members Pilot Program

3. Strategic Plan

4. The Problem Understanding Consistency Duties Policies Responsibilities
Case Review
Efficiency
Regional Review Board members have varying degrees of understanding about their duties, liver allocation policies, and the RRB process. Several RRBs meet during regional meetings or via conference calls to discuss specific cases as well as to determine a common approach to case review, while other RRBs rarely if ever convene as a group.  Members of the Liver Committee have requested more formal training of all Regional Review Board members to promote consistent review across the country.
Process of Denial
Process of Approval

5. Committee’s Response
Differentiate specific operational guidelines that may affect the review process
Describe the liver peer review process
Recognize an appropriate justification narrative
Identify approved exceptions outlined in OPTN/UNOS policies
The Liver Committee in conjunction with the liver transplant programs in Region 5 and UNOS staff have developed educational materials currently being piloted with the newest incoming RRB members in Region 5.
An online tutorial was developed which includes a slide set with speaker notes and an assessment tool. This module aimed to educate members of the RRBS so that they could identify specific operational guidelines that may affect the review process, better describe the liver peer review process, & understand what their responsibilities are as a review board members. Additionally, after completing the tutorial, members should recognize what constitutes an appropriate justification narrative, and be able to identify the approved exceptions outlined in OPTN/UNOS policies and specific regional guidelines.

6. Region 5 Rotation Rotates every six months
January 1
May 1
September 1
Rotates every six months
Staggered terms to allow for consistency
Additionally, rotation schedules were updated to eliminate many of the complications attributed to constant member turnover. The first group to pilot this effort completed the tutorial provided. In December, half of this group will rotate off the current Board and new members will be provided the same online tutorial.

7. National Review Board (NRB) for MELD/PELD Exceptions

8. Promote the Efficient Management of the OPTN
Strategic Plan
Goal 6:
Promote the Efficient Management of the OPTN
Simplify policies and procedures for efficient and effective implementation
Reduce unnecessary variation that increases programming costs
Reduce variation in the Regional Review Board Process

9. 2012 Board Resolution
In November 2013, the Board approved the following resolution by a vote of 34 in favor, 1 opposed, and 0 abstentions:
RESOLVED, that the Liver and Intestinal Organ Transplantation Committee is directed to develop a plan to include a conceptual basis and a proposed timeline for implementation of a National Liver Review Board  to be presented to the Board of Directors in June 2014.
As previously mentioned, the current RRB system does not promote consistent reviews/MELD scores across the US.

10. Committee Response
The preliminary construct was presented to the Board in June 2014, Board members urged the Committee to move forward in developing a formal proposal. The Committee is currently drafting a proposal for Spring 2015 Public Comment, likely for Board consideration in December 2015.

11. Thank you for your consideration. Questions?
David C. Mulligan, MD Committee Chair Ashley Archer-Hayes, MAS Committee Liaison