1. Julie Heimbach, M.D. Heimbach.Julie@mayo.edu Regional Councillor
Region 7 Meeting
Julie Heimbach, M.D.
Regional Councillor
Welcome to the fall Region 7 meeting. We know you took time out of your schedule to be here and your attendance is appreciated.

2. Purpose of Regional Meeting
Discuss regional business
Provide updates on OPTN/UNOS committee activities and projects
Discuss and comment on proposed policies and bylaws
Provide suggestions or alternatives to any proposals not supported
The purpose of regional meetings is to:
discuss regional business
receive updates on committee activities and projects
discuss and comment on proposed policies and bylaws.
Regional feedback on committee proposals and updates will be provided to the sponsoring committees.
In addition to comments and votes, if the region does not support one of the proposals, it is helpful for the committee to hear what the region would support.

3. Regional Business Summary of spring 2016 regional meeting
Summary of regional meeting includes:
Sponsoring committee’s response to regional comments on proposals
Board action on each proposal
Implementation date if computer programming is not required
A summary of the spring regional meeting is located in the booklet at your seat and is posted to Transplant Pro for your review. If you have suggested edits, please contact Betsy.
The summary provides information about the proposals that we discussed at the spring meeting, and where they stand now. For each proposal, the summary includes the sponsoring committee’s responses to our region’s comments, the Board action taken on each proposal, and information about implementation. Implementation dates are not yet set for proposals that require computer programming.

4. Regional Business
Spring public comment: January 23-March 24 (proposals reviewed by the Board in June)
A tentative date for the spring meeting will be circulated to the region for feedback
The regional meeting cycle is concurrent with the public comment cycle. The spring 2017 public comment cycle will begin on January 23 and end March 24. The public comment proposals we discuss during the spring regional meeting will be reviewed by the Board in June.
Regional Administration will send an to the region for feedback on a proposed spring meeting date in the next couple weeks.

5. Regional Business Councillor responsibilities
Moderate regional meetings, oversee regional business
Serve as the region 7 representative to the OPTN/UNOS Board of Directors
Present the region’s comments on public comment proposals and other OPTN/UNOS matters
To best represent the region, I need to hear from you
Welcome other members of the Board of Directors
As the regional councillor, I moderate regional meetings and oversee regional operations. Most importantly, I serve as the region 7 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 as my constituents. 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.

6. OPTN/UNOS Committee Nominations
Nomination period for regional representative nominations: September 12-October 12
Nomination announcement with link to online bio form will be sent by and posted on the Transplant Pro website
Nominations reviewed by Nominating Committee
Regional recommendations considered by OPTN/UNOS President- Elect
Appointments in April for terms beginning July 1
The nomination period for region 7 representative positions on committees began September 12 and ends October 12. An announcement was sent to the region and the information is posted on Transplant Pro. All nominations must be accompanied by a candidate bio form to be considered. The bio form is online.
The nominating committee is responsible for reviewing all nominations received from the region. The committee selection process is based on an individual’s professional experience, participation and engagement at a regional level, the needs of each committee for subject specific expertise, the ability of the candidate to represent the region at a national level, and the desire to have representation from as many areas of the region as possible.
Regional recommendations are considered and appointed by the OPTN/UNOS President-Elect. Committee appointments will be made in April for terms beginning July 1, 2017.

7. OPTN/UNOS Committee Nominations
Kidney Transplantation Committee
Liver and Intestine Transplantation Committee
Living Donor Committee
Membership and Professional Standards Committee (Associate Councillor)
Operations and Safety Committee
Patient Affairs Committee
Pediatric Transplantation Committee
Transplant Coordinators Committee
Here are the openings for terms beginning July All positions are 3 year terms except for MPSC which has a 2 year term.
Note about MPSC: The Associate Councillor serves as the MPSC Representative for two years and then as the Councillor and regional representative on the OPTN/UNOS Board of Directors for two years. Per OPTN bylaws this is an elected position. The next few slides will outline the proposed Region 7 guidelines for selecting candidates for the Associate Councillor slate.

8. Regional Business Regional Nominating Committee composition:
Issue: Historical lack of guidelines for composing the roster of the Nominating Committee
Regional Administrator has selected potential participants and proposed them to Councillor and Associate Councillor for approval
Proposed solution: Standardize the Nominating Committee roster with the following personnel:
Current Councillor
Associate Councillor
Immediate-Past Councillor
Region representatives to the OPO, Transplant Administrators, Transplant Coordinators Committees

9. Regional Business
State representation in Associate Councillor elections:
Issue: The election of Associate Councillor currently follows a three state rotation. North and South Dakota are not included in the rotation.
2015 – Illinois ( term)
2017 – Minnesota ( term)
2019 – Wisconsin ( term)
When the rotation was established, the Dakotas had few transplant programs
Proposed solution: Allow candidates from the Dakotas to apply at any time during the rotation.
If a member from either of the Dakotas is elected to serve as Associate Councillor:
The Dakotas will not put forward a candidate for the subsequent three election cycles.
For the next election, the state rotation cycle will return to the state that was supplanted by the member from North or South Dakota.

10. Regional Business
Nomination and voting process for Associate Councillor:
Issue: During the 2015 Associate Councillor election, confusion arose when members from one DSA put forward a candidate after the voting ballot had been distributed to the region.
A biography form was not submitted
The ballot was recalled, altered, and redistributed
Proposed solution: Publish guidelines clarifying the nominating/voting process:
Submit a biography form during the specified nomination period
Nominating Committee will select up to three candidates for the ballot
The state that is next in the rotation may submit a candidate endorsement to the Nominating Committee.
States may develop their own protocols for endorsing candidates; these protocols must be transparent within each state.
Ballots – finalized by the Nominating Committee – will go to designated voters at each OPO, transplant center, and independent HLA labs
Voting will determine the selection of the Associate Councillor

11. Regional Business
A ballot will go out later this month for voting members of each institution in the region to vote on these proposed modifications and clarifications.
Since not all institutions are represented at the regional meeting, we will need to send out a ballot to voting members at each institution.

12. Regional Meeting Agenda: Discussion
Discussion agenda format is the same as previous meetings
10 public comment proposals
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
None received
Proposals will be voted on today, but not presented or discussed
Proposals presented and discussed during national webinars
The proposals on the 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 2 proposals and 3 white papers that are anticipated to have a lower impact on the transplant community as a whole.
In previous correspondence, you were provided an opportunity to request that a proposal on the non-discussion agenda be added to the discussion agenda.
The 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 papers on non-discussion agenda
August 23 and September 20: 2-3:30 p.m.
Registration information located on Transplant Pro
One webinar was held earlier this week and a second webinar (identical in content) will be held on Sept 20 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
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)
This slide includes a list of the proposals that we need to vote on today. **Read the title of each proposal**
The plan is to take one vote on all 5 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 all 5 items: 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
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 shared today are posted online
Make sure to review the presentations that weren’t presented today
Histo, Minority Affairs, OPO, Pancreas, Pediatric, 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 posted 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. U.S. Deceased Donation, 7/1/2014 – 6/30/2016
Donors Recovered
Organs Recovered
Organs Transplanted
OTPD
7/1/2014-6/30/2015
8,836
31,111
26,909
3.045
7/1/2015-6/30/2016
9,513
33,746
29,111
3.06
% Change
7.7%
8.5%
8.2%
0.5%

21. U.S. Deceased Donors by Type and Region, 7/1/2014 – 6/30/2016
Regions 2, 3, 7, and 9 have the greatest percentages of ECDs with over 24%

22. Region 7 Deceased Donation,
7/1/2014-6/30/2016
Donors Recovered
Organs Recovered
Organs Transplanted
OTPD
7/1/2014-6/30/2015
710
2,659
2,237
3.151
7/1/2015-6/30/2016
771
2,773
2,350
3.048
% Change
8.6%
4.3%
5.1%
-3.3%

23. Region 7 Deceased Donors by Type, 7/1/2006 – 6/30/2016
38%
NOTE: 2007=7/1/2006-6/30/2007; 2008=7/1/2007-6/30/2008; 2009=7/1/2008-6/30/2009; 2010=7/1/2009-6/30/2010; 2011=7/1/2010-6/30/2011; 2012=7/1/2011-6/30/2012; 2013=7/1/2012-6/30/2013; 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

24. Region 7 Deceased and Living Donors, 7/1/2006-6/30/2016
NOTE: 2007=7/1/2006-6/30/2007; 2008=7/1/2007-6/30/2008; 2009=7/1/2008-6/30/2009; 2010=7/1/2009-6/30/2010; 2011=7/1/2010-6/30/2011; 2012=7/1/2011-6/30/2012; 2013=7/1/2012-6/30/2013; 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

25. U.S. Deceased Donor Transplants, 7/1/2013 – 6/30/2016
NOTE: 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

26. Region 7 Deceased Donor Transplants, 7/1/2013 – 6/30/2016
NOTE: 2014=7/1/2013-6/30/2014; 2015=7/1/2014-6/30/2015; 2016=7/1/2015-6/30/2016

27. Framing the day Full agenda
We want feedback from as many attendees as possible
To manage the discussion on 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 and what modifications could be made

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