1. Proposal to Establish Pediatric Training and Experience Requirements in the Bylaws Pediatric Transplantation Committee Spring 2015

2.  Pediatric training and experience not currently required for key personnel at programs that perform pediatric transplants The Problem

3. Project Timeline

4.  Establish a pediatric component requiring pediatric key personnel to demonstrate requisite training and experience Goal of the Proposal

5. Pediatric Kidney Component Qualifying Criteria Pediatric Primary Kidney Surgeon  Meet current Bylaws for Primary Kidney Surgeon  12 Kidney transplants in patients younger than 18 Pediatric Primary Kidney Physician Meet Bylaws requirements outlined in one of the following sections of Appendix E (Membership and Personnel Requirements for Kidney Transplant Programs), Section E.3 (Primary Kidney Transplant Physician Requirements):  3.C (Three-year Pediatric Nephrology Fellowship Pathway)  3.D (Twelve-month Pediatric Transplant Nephrology Fellowship Pathway)  3.E (Combined Pediatric Nephrology Training and Experience Pathway)

6. Pediatric Liver Component Qualifying Criteria Pediatric Primary Liver Surgeon  Meet current Bylaws for Primary Liver Surgeon  18 liver transplants in patients younger than 18 Pediatric Primary Liver Physician Meet Bylaws requirements outlined in one of the following sections of Appendix F (Membership and Personnel Requirements for Liver Transplant Programs), Section F.3 (Primary Liver Transplant Physician Requirements):  3.C (Three-year Pediatric Gastroenterology Fellowship Pathway)  3.D (Pediatric Transplant Hepatology Fellowship Pathway)  3.E (Combined Pediatric Gastroenterology/Transplant Hepatology Training and Experience Pathway)

7. Pediatric Heart Component Qualifying Criteria Pediatric Primary Heart Surgeon  Meet current Bylaws for Primary Heart Surgeon  8 heart transplants in patients younger than 18 Pediatric Primary Heart Physician  Meet current Bylaws requirements for Primary Heart Physician  Care for 8 heart transplant patients younger than 18 years of age  Has certification in pediatric cardiology by American Board of Pediatrics

8. Pediatric Lung Component Qualifying Criteria Pediatric Primary Lung Surgeon  Meet current Bylaws for Primary Lung Surgeon  4 lung transplants in patients younger than 18 Pediatric Primary Lung Physician  Meet current Bylaws requirements for Primary Lung Physician  Either this individual or another member of lung transplant team is certified by American Board of Pediatrics in pediatric pulmonary medicine

9. Supporting Evidence  Programs that meet volume criteria today responsible for 98% of pediatric transplants  Equitable geographic access  Significantly better graft and patient survival for pediatric KI, LI, and HR transplants performed at high versus low volume programs

10. Geographic Location of Centers Performing Pediatric Kidney Transplants, 1/1/05-7/31/14 Centers with > 12 pediatric transplants Centers with < 12 pediatric transplants 98% of pediatric transplants were done at centers meeting the proposed volume criteria

11. Geographic Location of Centers Performing Pediatric Liver Transplants, 1/1/05-7/31/14 Centers with > 18 pediatric transplants Centers with < 18 pediatric transplants 97% of pediatric transplants were done at centers meeting the proposed volume criteria

12. Geographic Location of Centers Performing Pediatric Heart Transplants, 1/1/05-7/31/14 Centers with > 8 pediatric transplants Centers with < 8 pediatric transplants 98% of pediatric transplants were done at centers meeting the proposed volume criteria

13. Geographic Location of Centers Performing Pediatric Lung Transplants, 1/1/05-7/31/14 Centers with > 4 pediatric transplants Centers with < 4 pediatric transplants 93% of pediatric transplants were done at centers meeting the proposed volume criteria

14.  If applying for a pediatric component:  Attend webinar  Obtain and complete application  Notify OPTN of any personnel changes  If not applying for a pediatric component:  Notify OPTN  Follow transition plan to remove pediatric candidates from waiting list What Members will Need to Do

15.  Eileen Brewer, MD Committee Chair ebrewer@bcm.edu  Regional representative name (RA will complete) Region X Representative email address  Christine Flavin, MPH Committee Liaison christine.flavin@unos.org Questions?

16. Number of Pediatric Transplants at Centers Meeting the Proposed Pediatric Volume Criteria, 1/1/05-7/31/14 Organ Transplanted Transplants at Centers Meeting the Proposed Criteria Total Number of Pediatric Transplants N%N Kidney7,47998.47,599 Liver5,20797.05,369 Heart3,36697.83,440 Lung47292.5510 * Volume Criteria:  Kidney: At least 12 transplants in recipients <18 years  Liver: At least 18 transplants in recipients <18 years  Heart: At least 8 transplants in recipients <18 years  Lung: At least 4 transplants in recipients <18 years

17. Unadjusted Kaplan-Meier Survival by Center Volume* for Pediatric Kidney Transplants, 1/1/95-12/31/10 Graft Survival Patient Survival * Low volume: Ctrs with <12 transplants in 1995-2010; High volume: Ctrs with 12+ transplants in 1995-2010 p-value<0.001p-value=0.02

18. Unadjusted Kaplan-Meier Survival by Center Volume* for Pediatric Liver Transplants, 1/1/95-12/31/10 Graft Survival Patient Survival * Low volume: Ctrs with <18 transplants in 1995-2010; High volume: Ctrs with 18+ transplants in 1995-2010 p-value<0.01p-value<0.001

19. Unadjusted Kaplan-Meier Patient Survival by Center Volume* for Pediatric Heart Transplants,1/1/95-12/31/10 * Low volume: Ctrs with <8 transplants in 1995-2010; High volume: Ctrs with 8+ transplants in 1995-2010 p-value=0.04

20. Unadjusted Kaplan-Meier Patient Survival by Center Volume* for Pediatric Lung Transplants,1/1/95-12/31/10 * Low volume: Ctrs with <4 transplants in 1995-2010; High volume: Ctrs with 4+ transplants in 1995-2010 p-value=0.25

21. Region 1

22. Region 1 – Kidney Transplants, 1/1/05-7/31/14

24. Region 1 – Liver Transplants, 1/1/05-7/31/14

25. Region 1 – Heart Transplants, 1/1/05-7/31/14 Region 1 – Lung Transplants, 1/1/05-7/31/14

26. Region 6

27. Region 6 – Kidney Transplants, 1/1/05-7/31/14

28. Region 6 – Liver Transplants, 1/1/05-7/31/14

29. Region 6 – Heart Transplants, 1/1/05-7/31/14 Region 6 – Lung Transplants, 1/1/05-7/31/14

30. Region 9

31. Region 9 – Kidney Transplants, 1/1/05-7/31/14

33. Region 9 – Liver Transplants, 1/1/05-7/31/14

34. Region 9 – Heart Transplants, 1/1/05-7/31/14 Region 9 – Lung Transplants, 1/1/05-7/31/14

35. Region 5

36. Region 5 – Kidney Transplants, 1/1/05-7/31/14

39. Region 5 – Liver Transplants, 1/1/05-7/31/14

41. Region 5 – Heart Transplants, 1/1/05-7/31/14

43. Region 5 – Lung Transplants, 1/1/05-7/31/14

44. Region 2

45. Region 2 – Kidney Transplants, 1/1/05-7/31/14

48. Region 2 – Liver Transplants, 1/1/05-7/31/14

49. Region 2 – Heart Transplants, 1/1/05-7/31/14

51. Region 2 – Lung Transplants, 1/1/05-7/31/14