1. Pediatric Transplantation Committee Regional Meeting Update Fall 2012

2. Ongoing Committee Initiatives
Thoracic Working Group
Finalizing recommendations to modify pediatric heart allocation
Spring 2013 Public Comment Cycle
Working with the Heart Subcommittee of the Thoracic Committee
The Pediatric Committee’s Thoracic Working Group and the Thoracic Committee’s Heart Subcommittee have been working together to analyze pediatric heart allocation policy for possible improvements. They are finalizing proposal language and anticipate distributing it for public comment in the spring.

3. Ongoing Committee Initiatives
Pediatric Heart Proposal Will Address
Heart Status 1A and Status 1B listing criteria
Criteria to qualify for an ABO-incompatible heart transplant
Allocation priority of qualified ABO- incompatible heart candidates
In utero listings
The policy proposal will include:
Modifications to the Pediatric Heart Status 1A and Status 1B listing criteria
Modifications to the criteria to qualify for ABO-incompatible heart transplant
Modifications to the allocation priority of qualified ABO-incompatible heart candidates and
The elimination of in utero listings
Note: If there are specific questions about details- below are the changes that will be proposed:
Pediatric Status 1A Heart Criteria
(a)Requires assistance with a ventilator;
(b)Requires assistance with a mechanical circulatory support device;
(c)Requires assistance with an intra-aortic balloon pump;
(d)Has ductal dependent pulmonary or systemic circulation with ductal patency maintained by stent or prostaglandin infusion; (new)
(e)Has a congenital heart disease diagnosis (excluding minor lesions such as atrial septal defect, ventricular septal defect, PDA, or biscupid aortic valve); is admitted to the listing center hospital; and, requires infusion of high dose or multiple inotropes (new)
(f) By exception
Pediatric Status 1B Heart Criteria
Has a diagnosis of cardiomyopathy and requires infusion of one or more intravenous inotropic agents (new)
(b) Has a diagnosis of congenital heart disease and requires infusion of low dose single inotrope (new)
(c) By exception
ABO-incompatible Criteria
-higher isohemagglutinin titer eligibility, potentially 1:16
ABO-incompatible Allocation
-Classify ABO-incompatible candidates as a “secondary” blood match

4. Ongoing Committee Initiatives
Kidney Working Group
Exploring regional sharing for highly- sensitized pediatric kidney candidates
Our Kidney Working Group and members of the Kidney and Histocompatibility Committees are exploring regional sharing for highly-sensitized, pediatric kidney candidates.
The Kidney Working Group has drafted a concept brief based on its discussions thus far. It is now working to flesh out the details of this concept by getting feedback from, and building consensus with, groups of the transplant community that would be integral to the success of this allocation schema.

5. Ongoing Committee Initiatives
Pediatric Transplant Training & Experience
Problem: OPTN bylaws do not require pediatric transplant experience
Recommending bylaw changes to MPSC
Finally, the entire committee is working to address what we believe is a deficiency in the current OPTN bylaws. Just like every other transplant program, key personnel at transplant programs that primarily transplant pediatric patients must meet the requirements in one of several “pathways” for each respective organ. BUT, the bylaws do NOT require key personnel at those programs that primarily transplant pediatric patients to have any pediatric transplant training or experience. Part of the problem is that the bylaws do not define what constitutes a pediatric transplant program.
We recognize that pediatric transplantation is a specialty within the field of transplantation. Therefore, we are developing recommendations to address this void in the bylaws for the Membership and Professional Standards Committee’s consideration. Our recommendations will include a formal definition for “pediatric transplant programs.” We have discussed using the definition from the CMS Conditions of Participation - a pediatric transplant program is one that performs 50% or more of its transplants on pediatric patients in a 12-month period.

6. Pediatric Committee Contacts
Chair: Heung Bae Kim, M.D.
Vice-Chair: Eileen Brewer, M.D.
Staff Committee Liaison: Chad Waller
Are there any questions?