1. Membership & Professional Standards Committee (MPSC)
OPTN/UNOS Board of Directors
Jonathan Chen, MD, Chair
Deborah Sudan, MD, Vice Chair
November 12-13, 2014

2. Ongoing Committee Initiatives
Fall 2014 Public Comment issues:
OPTN Quality Assurance and Process Improvement (QAPI) requirement
Promotes patient safety & improves post-transplant survival
Pre-Transplant Performance Review
Increase access to transplants.
Refine Transplant Hospital Definition
Promote the efficient management of the OPTN
QAPI Requirement:
The Membership and Professional Standards Committee (MPSC) has noted that members having difficulty with compliance or performance often do not have well-developed quality assessment and performance improvement (QAPI) programs. Currently, OPTN bylaws do not require that members establish and implement a QAPI program. Motivated by this observation, the MPSC proposes modifications to OPTN Bylaws that require members to implement a QAPI program that must include certain essential elements that are outlined in the proposed Bylaws. This proposal addresses the OPTN key goals of promoting transplant patient safety and improving post-transplant survival. The proposal will provide a tool to the MPSC to encourage and assist OPTN members in the development and implementation of robust QAPI programs. A requirement that members develop and implement a comprehensive QAPI program should assist members in their efforts to improve performance and remain in compliance with OPTN obligations, thereby promoting patient safety and improving post-transplant survival.
Pre-Transplant Performance Review:
Currently, transplant program performance monitoring relies almost exclusively on risk-adjusted graft and patient survival rates among recipients. The overemphasis on post-transplant metrics may result in risk-aversion and decreased transplant volumes, and may not be in the best interest of waitlisted patients.  Further, post-transplant outcomes may not identify structural problems (e.g., understaffing) that prevent a program from keeping up with the needs of its waitlist population. As such, a more holistic approach to performance monitoring is necessary.
The purpose of this proposal is to provide the MPSC with a tool, the Composite Pre-transplant Metric (CPM), for identifying kidney and liver programs that may be in need of review based on outlying performance in accepting deceased donor organ offers, transplanting waitlisted patients, and/or mitigating waitlist mortality. The CPM is an aggregate, pre-transplant performance metric that combines programs’ acceptance rate, geography-adjusted transplant rate, and waitlist mortality rate observed-to-expected (O/E) ratios into a single number for prioritizing programs for potential review.
The proposal addresses the OPTN key goal of increasing access to transplants. Specifically, the proposal helps the OPTN meet the objective of promoting the best use of donated organs. The proposal provides a meaningful metric to identify potential issues with pre-transplant performance and waiting list practices, in addition to identifying best practices. The strategic plan includes many areas for focus including sharing best practices with the transplant community as well as facilitating patient access. This metric will be used to evaluate member programs that may not be effectively managing the waiting list and identify opportunities to increase access to transplantation.
Transplant Hospital Definition:
Changes in institutional management at many medical healthcare facilities have revealed a need for the MPSC to take a look at what defines a transplant hospital when assessing requests for OPTN membership and transplant program designation and approval. A work group met four times during this committee cycle to recommend what are the attributes which are needed in the transplant hospital definition. The MPSC approved proposed bylaw language on a conference call earlier this month and anticipates the proposal going out for public comment in the Fall of this year.

3. Ongoing Initiatives Review of bylaw requirements/qualifications for primary surgeons and physicians
Approved Transplant Fellowship Training Programs
Foreign Board Certification
Primary Physician specialty, subspecialty board certifications
Consider multi-organ procurement requirement for primary surgeon criteria
Primary Surgeon Procurement Requirement
Consider primary surgeon qualification - primary or first assistant on transplant cases
Reassess currency requirements for primary surgeons and primary physicians
Consider requirement for primary physician observation of procurements
Pancreas Bylaws Review (Pancreas Committee)
Define working knowledge for primary physician qualification pathways
Earlier this spring the Joint Society Steering Group- comprised of representatives HRSA, UNOS, AST, ASTS, and NATCO- decided that a number of MPSC projects, and one Pancreas Committee project, related to key personnel requirements in the Bylaws should be addressed by a Joint Society Working Group. This group will be reviewing and making recommendations on Bylaws pertaining to the topics seen on this slide. The Joint Society Working Group is in the midst of discussing these topics, and the MPSC will be receiving an update on its progress during its December 2014 meeting. Proposed modifications pertaining to these topics can be anticipated in fall 2015.

4. Organ Perfusion Membership Standards
Questions about private, third-party perfusion companies and OPTN membership
Recognition that perfusion technology for other organs on the horizon
Address in general manner, applicable to all organs
The EVLP Working Group of the Thoracic Committee had raised questions about private, third-party perfusion companies and OPTN membership. Considering these questions, it was recognized that other similar technologies for other organs are on the horizon. As such, it was request that a working group be formed- comprised of members of the EVLP working group and abdominal specialists- to consider the implications of OPTN oversight, and if determined to be necessary, to recommend general principles that could be applicable to other emerging technologies.

5. Questions?
Jonathan Chen, MD, Chair, MPSC Seattle Children’s Hospital MPSC Liaisons Sally Aungier - Jacqui O’Keefe -