Pediatric Transplantation Committee Fall 2015

Recent Public Comment Proposals Pediatric Classification for Liver Candidates Turning 18 Board approved: June 1, 2015 Implementation date: Sept 1, 2015 Pediatric Training and Experience in the Bylaws Failed to pass by a majority (19-Yes, 16-No, 3-Abstain) Board directed to work with interested stakeholders to revise Currently out for public comment In January 2015, the Pediatric Transplantation Committee released a proposal for public comment that would automatically transfer pediatric classification for all candidates who turn 18 while waiting for a liver transplant. It also eliminated the pediatric classification exception process for an adult candidate who was ever on the waiting list before age 18 but has since been removed and reregistered. The proposal was included on the non-discussion agenda at the regional meetings and received favorable public comment. The Committee did not make any post-public comment modifications to the policy language. The Board approved the proposal as part of the consent agenda on June 1, 2015. The policy will be implemented on September 1, 2015. No action is required of liver programs. In January 2015, the Committee also released a proposal to establish pediatric training and experience requirements in the Bylaws. This proposal was controversial throughout the public comment period, receiving support from pediatric specialists and parents but not from regional meeting attendees or the ASTS. The Committee proceeded to the Board without post-public comment modifications to the proposal. Although the proposal failed to pass by a majority of the Directors (19-Yes, 16-No, 3-Abstain), the Committee achieved consensus on the need to recognize pediatric transplantation as a subspecialty through pediatric membership requirements. The Board directed the Committee to work with interested stakeholders to revise the proposal to include stratified case volume requirements and submit it for public comment in August 2015. This proposal is currently out for public comment.

Policy Implementation Dates Proposal Board Approved Implementation Date Pediatric Liver: Remove ICU Reqs and Modify Hepatoblastoma Reqs Nov 15, 2011 March 25, 2015 Pediatric Classification for Liver Candidates Turning 18 June 1, 2015 Sept 1, 2015 Change Pediatric Heart Allocation Pediatric Status 1A and 1B criteria ABOi eligibility Improve priority of infants and ABOi-eligible Eliminate in utero heart registrations June 24, 2014 2nd quarter, 2016 In November 2011, the Board approved changes to pediatric liver policy to remove intensive care unit (ICU) requirements and modify hepatoblastoma requirements. Pediatric liver candidates no longer must be located in a hospital’s ICU in order to be listed as Status 1A or Status 1B. Pediatric liver candidates with non-metastatic hepatoblastoma, proven by a biopsy, may be immediately listed as Status 1B (without prior listing at MELD/PELD 30). These policies had already been implemented through interim solutions; however, now they have been programmed in UNetSM. The Committee is now monitoring the implemented policies and will evaluate whether they have achieved their intended outcomes in the spring of 2017. As described in the previous slide, automatic transfer of pediatric classification for registered liver candidates turning 18 will be implemented on September 1, 2015. No action is required of liver programs. In June 2014, the Board approved four modifications to pediatric heart allocation policy: Redefine pediatric heart Status 1A and 1B criteria. Increase isohemagglutinin titers needed to qualify for ABO-incompatible heart offers to 1:16 or less for candidates who are one year of age or older but registered before their second birthday. Improve allocation priority of urgent heart candidates registered before their first birthday, as well as candidates eligible to receive ABO-incompatible heart offers. Eliminate in utero heart registrations. Programming is scheduled to begin in the 4th quarter of 2015, and the policy will be implemented during the 2nd quarter of 2016.

Questions? Eileen Brewer, MD Committee Chair ebrewer@bcm.edu Christine Flavin, MPH Committee Liaison christine.flavin@unos.org