1. What’s up at UNOS. Yolanda Becker, M. D
What’s up at UNOS? Yolanda Becker, M.D. UNOS/OPTN President Professor of Surgery Director of Kidney and Pancreas Transplant University of Chicago
Fall 2017 cycle

2. Current Issues Fall Regional meetings
Public Comment open until Oct 2nd
Developing Strategic plan
New Research and Business Plan
Financial projections
Estimating Registration fees

3. Regional Meeting Information
Information about each region is available on Transplant Pro Website. To find out details about the meetings, including hotel information and meeting materials, visit the Transplant Pro website. The region section is located under the “community” tab.
Hotel information will be added as contracts are finalized and an announcement will be sent to the region in advance of the meeting.

4. Regional Meeting Agenda
Regional Councilor presentation
Region’s elected liaison between the Board and the region
Board members are introduced
Update from UNOS executive staff, Board Pres/VP
Review and discuss public comment proposals
Learn about committee activities and provide feedback
Regional breakout sessions
Discussion sessions: topics of interest
Here is a typical regional meeting agenda. Each region has a regional councillor who is elected to represent them on the Board of Directors. The councillor begins the regional meeting with a presentation that includes region specific information and donation and transplantation data. Board members are introduced during this presentation.
Members also receive an update on OPTN and UNOS activities presented by UNOS executive staff or the President or Vice-President. The bulk of the meeting is used to learn about proposals that are out for public comment. The proposals are presented by the regional representatives to the OPTN committees, and are discussed and voted on at the meeting.
Committee members also present updates on committee activities to inform members of policy implementations, or to obtain feedback on draft proposals before public comment.
Some regions have breakout sessions the morning of the regional meeting, for example organ specific, OPO, and transplant administrator breakouts.
We tried something new during the spring meetings and offered the regions an opportunity to submit ideas for topics. We discussed a few topics during the meetings; including living donation, system optimization, and drug overdose deaths in organ donation. We hope to continue to offer this session.

5. What do we do with the public comments?
Committee monitors public comments weekly
At end of public comment period, committee will look at compiled comments, discuss themes, and make final recs to Board
Committee will include a discussion of public comments and how they were addressed/considered in briefing paper to Board
Briefing paper posted on OPTN website after Board meeting

6. OPTN/UNOS Strategic Planning

7. Brainstorming themes Better matching Focus on improvement
Faster placement, including analysis of historical offer acceptance
Automated decision-making aids (risk/benefit calculator, time to next offer)
Use of behavioral research to improve system interface
Focus on improvement
Peer coaching, effective practice sharing, COIIN
Re-examine outcomes thresholds, including development of long- term outcomes
More data, more easily
APIs, automated connections to EMRs
User-friendly DonorNet and other tools (DonorNet mobile, multi- platform, interface design)
Analysis tools – ROO, RUM, benchmark reports

8. Themes--Match More Equity Outcomes Safety Efficiency
Automated decision-making tools
Organ transport efficiency
Better placement based on historical data
Revise offer response time policy
National KPD system
Longevity matching for all organs (net benefit)
Re-examine multi-organ allocation policy
Survival risk/benefit calculator
EMR integration to allow for updates on infectious disease results
System enhancements for reporting HLA to improve virtual crossmatching
Streamline policy development and implementation
More effective public comment
Improve diversity on Board and committees
Each table brainstormed as a group using a matrix that lists the 5 strategic goals and our three core competencies: match, data, quality.
We had each group fill out their matrix of ideas individually first and then vote for the most impactful ideas, using the guidelines that the idea is aligned, viable, impactful, and measurable.
At the end of the session, we were left with a long list of ideas to refine and discuss further.
In my experience, this matrix is a much better way of wrapping my head around what role we, as UNOS and the OPTN, play in the furtherance of these goals. I’ve heard a lot of people say “why is our #1 goal more transplants? We don’t have the ability to influence that.” But that is not really true if you look at our work in the areas of match, data, and quality and how it might influence this goal. For instance, can we change policies and programming to expedite organ placement? Can we use the data we have from OPOs who increased their volumes and create a forum for sharing this information with other OPOs.

9. Themes--Data More Equity Outcomes Safety Efficiency
Utilize behavioral analytics to revise offer system
Develop equity benchmark for all organs
Develop center comparison reports
Collect long-term outcome data
Customize transplant center and OPO specific reports and offer UNOS staff interpretation
Share data on best practices and near misses
EMR integration
Standardize rules for data collection
Each table brainstormed as a group using a matrix that lists the 5 strategic goals and our three core competencies: match, data, quality.
We had each group fill out their matrix of ideas individually first and then vote for the most impactful ideas, using the guidelines that the idea is aligned, viable, impactful, and measurable.
At the end of the session, we were left with a long list of ideas to refine and discuss further.
In my experience, this matrix is a much better way of wrapping my head around what role we, as UNOS and the OPTN, play in the furtherance of these goals. I’ve heard a lot of people say “why is our #1 goal more transplants? We don’t have the ability to influence that.” But that is not really true if you look at our work in the areas of match, data, and quality and how it might influence this goal. For instance, can we change policies and programming to expedite organ placement? Can we use the data we have from OPOs who increased their volumes and create a forum for sharing this information with other OPOs.

10. Themes--Quality More Equity Outcomes Safety Efficiency
Reduce regulatory disincentives
Monitor offer acceptance patterns
Re-examine survival thresholds, use longer-term outcomes
Share best practices from high performing transplant centers and OPOs
Share best practices and near misses
Peer coaching
Revise process for member reviews, actions, and due process
Each table brainstormed as a group using a matrix that lists the 5 strategic goals and our three core competencies: match, data, quality.
We had each group fill out their matrix of ideas individually first and then vote for the most impactful ideas, using the guidelines that the idea is aligned, viable, impactful, and measurable.
At the end of the session, we were left with a long list of ideas to refine and discuss further.
In my experience, this matrix is a much better way of wrapping my head around what role we, as UNOS and the OPTN, play in the furtherance of these goals. I’ve heard a lot of people say “why is our #1 goal more transplants? We don’t have the ability to influence that.” But that is not really true if you look at our work in the areas of match, data, and quality and how it might influence this goal. For instance, can we change policies and programming to expedite organ placement? Can we use the data we have from OPOs who increased their volumes and create a forum for sharing this information with other OPOs.

11. New plan structure Combined OPTN and UNOS plans
Shared high-level goals
Description of current activities
Opportunities for growth
Metrics
So, let’s talk about how we are going to structure the new plan, keeping in mind some of the OFIs I mentioned.
First, the next three-year plan will be structured differently than the last. We will no longer have two plans but one overarching plan that has shared, high-level goals, a description of core activities, opportunities for growth (new initiatives) and the key metrics we will use to assess whether we are successfully meeting our goal and objectives.

12. New Research Collaboration Innovation and Improvement Network
Behavioral studies
Systems Optimization

13. Cohort A Organ Acceptance Rate (50-100% KDPI)
Kick-off and data collection
Waitlist Management
Organ Offer &
Acceptance

14. COIIN Benefits from Cohort A Teams
“Bringing team together around common goals”
“Collaboration with other centers” and “Hearing the issues discussed with other centers”
“The review of offer acceptance criteria brought a lot of opportunities to our attention”
“Increased awareness by entire team”
“COIIN helped our collaboration with the OPO”
“Transparent data across all participants and contact information for collaboration across centers”

15. Next Steps
Jul 17 –Sep 17
Final 90-day improvement cycle for Cohort A (Care Coordination)
Coaching Visits for Cohort B
Oct 17 – Dec 17
Support for “holding the gains” for Cohort A and continued data updates
Kick-off meeting for Cohort B
First 90-day improvement cycle for Cohort B (Waitlist Management)

16. New projects to help Centers

17. Peds Benchmark Report
NOTES: Announcement of new ped tx center benchmark report
Adult only data removed
Comparison groups restricted to under 18
Supplement” to standard report on data portal
Reminder that benchmark reports are issued quarterly for all organs
OPO benchmark likely release next spring

18. Recovery and Usage Maps (RUM) Report
NOTE: The RUM report visually identifies discards by OPO or TXs by center, within parameters you define using the sliders below . . .

19. Recovery and Usage Maps (RUM) Report

20. Data Services Portal
Note: RUM and many other reports are available on the self-serve data services portal

21. Up Next for the Data Portal
Visual living donor follow-up dashboard
Reports to improve data quality
Data submission compliance (CMS and OPTN)
Waiting list management tool for other organs
What else would be helpful? TELL US!

22. Liver distribution

23. Liver Committee Work Plan
Enhance
NLRB 
HCC 
Purpose: Revise exception eligibility criteria.
Board Approved: Dec 2016
Purpose: Optimize the distribution system to reduce geographic variation in access to transplant
Public Comment (2): July 31,2017
The Liver committee is working simultaneously on three parts of the liver system, including establishing a National Liver Review Board (NLRB) to replace the Regional Review Boards and revising the standard eligibility criteria for the largest reason for exception, Hepatocellular Carcinoma (HCC). With these revisions to the exception system, the MELD/PELD exception scores will more accurately reflect the patient’s disease severity and are the same regardless of geography.
Purpose: Apply exception criteria uniformly.
Board Approved: Jun 2017

24. Collaboration and Compromise
Proposing 11-district sharing with 150 mile proximity circle including out of district patients:
5 additional MELD/PELD points in proximity circle
Sequence: Local Status 1A,Peds 1B, Region plus proximity circle
Share to: Adults: lab MELD > 29 Pediatrics: allocation MELD/PELD > 29
DCD and donors > age 70 excluded from this sharing algorithm
We recognized that addressing liver geography is a test of the ability of the donation and transplant community to effectively govern the transplant system. Therefore we asked regional councilors and key stakeholders to identify attendees with divers meeting to attend a meeting yesterday in Miami. OPTN leadership, the chair and vice-chair of the Liver-Intestine Committee, and two committee members were also present.

25. Fall Public Comment
Rationale for moving forward in parallel with additional modeling:
Direction and magnitude of impact on key metrics were consistent across older and newer cohorts.
Proposed solution will share to fewer proximity circle candidates than previous modeling (suggesting the prior modeling is a ceiling)
Sharing using MELD/PELD 29 threshold
Sharing based on lab MELD for adult candidates
Some additional modeling data will become available during public comment period

26. Fall Public Comment SRTR Modeling (preliminary results 8/11):
Results similar to prior analyses
Final Report will include impact on vulnerable populations.
Will Seek Feedback on Final Modeling Data
Ongoing Liver Committee Work:
Finalize disparity / impact metrics
Set targets for improvement
Additional policy modifications to meet disparity targets

27. Parallel OPTN/UNOS Work
System Optimization Proposal
Reduce time to access and respond to offers (60 to 30 min)
Limit number of simultaneous acceptances to two donors
OPO / DSA Performance Metrics
Determination of Cost and Logistics

28. Volunteers are Valuable!!
41,762 Volunteer hours
Average number of hours 1-2 hours per week
Connection to the Transplant community
Meaningful and impactful work

29. The country is divided into 11 UNOS regions
The country is divided into 11 UNOS regions. Each region is assigned a regional administrator who is the primary point of contact for members in their assigned regions. The regional administrator is also responsible for organizing and facilitating regional meetings. There are four of us, and listed here are the regions we are each assigned. Please feel free to contact your regional administrator with questions about OPTN policy or regional meetings.