1. Christian Kuhr, MD Regional Councillor
Region 6 Meeting
Christian Kuhr, MD
Regional Councillor
Welcome to the “spring” Region 6 meeting. We know you took time out of your schedule to be here and your attendance is appreciated.

2. Meeting agenda Update from OPTN/UNOS leadership
Regional discussion session – New!
Rise in heroin deaths
Accepting organs from PHS High risk donors
System optimization
Review and discuss 3 public comment proposals
Your feedback will be shared with the Kidney and Liver Committees
Update: Ethics proposal to revise the white paper addressing financial incentives for organ donation is no longer out for public comment
Updates on committee activities: Kidney, Liver, Transplant Coordinators (will present after the liver presentations)
Today’s meeting includes
An update from OPTN/UNOS leadership
A regional discussion session – this is a new addition to the meetings, and one we hope to continue depending upon the number of agenda items we have to discuss. We would like for you to contribute topic ideas for future meetings – this is an opportunity to have a region-wide discussion about a regional or national issue.
discuss and comment on proposed policies – your feedback will be shared with the sponsoring committees
UPDATE to agenda: the Ethics Committee’s proposal to revise the white paper addressing financial incentives for organ donation is pulled from public comment. The committee will assesses potential edits and intends to reissue a revised paper for public comment at a later date.
We will also hear updates from the Kidney, Liver and Transplant Coordinators Committees. The Transplant Coordinators Committee will report at the end of the day, just after the liver committee’s presentations.

3. Regional Business Summary of fall 2016 regional meeting
Why should you review it?
Committee’s response to our region’s comments
Board’s action on each proposal
Information on implementation date
A summary of the fall regional meeting is located in the booklet at your seat and is posted to Transplant Pro for your review.
The summary provides information about the proposals that we discussed at the spring meeting, and where they stand now. The summary includes each committee’s response to our region’s comments, the Board action taken on each proposal, and information about implementation. Implementation dates are not available for proposals that require computer programming.

4. Fall regional meeting date
Fall public comment: July 31 – October 2, 2017
proposals will go to the Board for review in December
Fall 2017 region 6 meeting:
Monday, September 25 in Honolulu, HI
The regional meeting cycle runs concurrent with the public comment cycle. The fall 2017 public comment cycle will begin on July 31 and end October 2. The public comment proposals we discuss at the fall regional meeting will be reviewed by the Board in December.
The fall regional meeting will be held in Honolulu on Monday, September 25. Please note that we are meeting on a different day of the week.

5. Region 6 Meeting Attendance
This is a chart showing the percent of Transplant Centers and OPOs represented at regional meetings nationally in red and Region 6 in blue. You can see that we are consistently above the national average.

6. Regional Business Councillor responsibilities
Moderate regional meetings, oversee regional business
Serve as the region 6 representative to the OPTN/UNOS Board of Directors
Present the region’s feedback on public comment proposals and other OPTN/UNOS matters
To best represent the region, I need to hear from you
Welcome members of the Board of Directors
As regional councillor, I moderate regional meetings and oversee regional operations. Most importantly, I serve as the region 6 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. 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. (As far as I know the only other Board member who will be at the meeting is Yolanda Becker to give the UNOS Update)
Board members from the region are: myself and Jonathan Chen

7. OPTN/UNOS Committee Nominations
Regional nominating committee selected primary and secondary representatives for each vacancy
Committee leadership is reviewing committee rosters, and finalizing for OPTN President-Elect review
Purpose: ensure staffing needs of the committees are met, and expertise needed for project work is represented
President-Elect reviews the membership of all committees
Purpose: goal is for the committee system to represent the community we serve - balance of professions, opinions, race, gender
New committee members will receive notice by early April
Thank you to everyone who submitted a nomination to serve as a region 6 representative on a committee. I met with our region’s nominating committee, and we selected candidates for each committee vacancy based on:
-professional experience
-staffing needs of each committee
-diversity in profession and demographics
-past history of regional engagement
-past history of the candidate’s ability to represent both regional and national perspectives
-geographic balance in the region
The committee chairs are reviewing the rosters now to make sure each committee has the members it needs to do the work of the committee over the next year. OPTN President-Elect, Yolanda Becker, will review the committee rosters to make sure the committee system represents the community we serve and includes a balance of specialties, opinions, race and gender. Members appointed as regional representatives will receive notice by early April.
Committee terms for new regional representatives will begin July 1, 2017.
FYI – in case you need it, the Nominating Committee membership includes the councillor, associate councillor and immediate past councillor.

8. Region 6 Vacancies on Committees, terms begin July 1
Operations and Safety Committee
Pancreas Transplantation Committee
Pediatric Transplantation Committee
Transplant Coordinators
Here is a list of committee vacancies that we received nominations for in the fall with terms beginning July 1.

9. Committee Representation
vs : Demographics
We are still working through the appointment process to make sure our committee membership is as aligned as it can be with the community we serve, but we wanted to share the progress we’ve made so far.  This data includes committee members whose terms begin July 1, including both new and returning members.  We’ve achieved a balance with the gender of our committees members, and made progress with ethnic diversity.  The Board governance subcommittee requested that we focus on increasing representation among Hispanic and African American groups (as these are underrepresented on our Board and committees in comparison to their numbers on the waitlist), and this will continue to be an area of focus for us. 

10. Region 6: Gender
Counts/frequency: Male (10, 58.8%), Female (7, 41.2%)

11. Region 6: Ethnicity/Race
Counts/frequency: Caucasian (non-Hispanic) (14, 82.4%), Hispanic/Latino (1, 5.9%), African American (0, 0.0%), American Indian (0, 0.0%), Asian/Pacific Islander (1, 5.9%), Other race/ethnicity/orgin (0, 0.0%), Decline to answer (1, 5.9%)

12. Some of the challenges with the current Committee structure
11 of 18 individuals on most Committees are selected by a group other than the committee and OPTN leadership
Lack of diversity (perspectives, demographics, professions) due to disjointed appointment process
Review all committee rosters to identify specialties and demographics that are underrepresented
Here are some of the challenges with the current committee structure:
- 60% of each committee’s membership is determined by groups other the committee leadership. The committees are identifying their staffing needs and the expertise they need for certain projects and the regions are considering these needs when reviewing nominations and making selections.
- There is a need for a group to oversee the entire appointment process to identify areas where the committee system is underrepresented in certain categories such as professions, perspectives, and demographics.

13. Regional Meeting Agenda: Discussion
Discussion agenda format is the same as previous meetings
3 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.

14. 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
Proposals will be voted on today, but not presented or discussed
Proposals presented and discussed during national webinars
The proposals on the non-discussion (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.
You were provided an opportunity to request that a proposal on the non-discussion agenda be moved to the discussion agenda. We didn’t receive any requests to remove the 2 proposals we will vote on today from the non-discussion agenda.
The proposals on the non-discussion agenda will be voted on today, but they will not be presented or discussed.

15. National Webinars
Two webinars to present and discuss the proposal and guidance document on non-discussion agenda
Recording on Transplant pro website in the “region” section.
One webinar was held in January and a second webinar (identical in content) was held on February 27 to present summaries of the proposal and guidance document. Members were given an opportunity to ask questions and provide feedback on the webinars. A recording of the webinar is located in the “region” section of the Transplant Pro website.

16. Non-Discussion Proposals: Vote You have the option to abstain from voting if you haven’t reviewed the proposals
Rewrite of Bylaws Article II: Board of Directors (Executive Committee)
Histocompatibility Testing Guidance Document (Histocompatibility Committee)
This slide includes a list of the proposals that we will vote on today. **Read the title of each proposal**
The plan is to take one vote on these 2 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 the 2 items: yes, no, abstentions
If hands are raised: vote on each proposal separately – yes, no, abstentions

17. Public Comment Opportunities
Contact Regional Representatives
List is located on Transplant Pro: select the community tab, and then “regions”
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 presented today are posted on Transplant Pro
Make sure to review the presentations that weren’t presented today
Histo, OPO, Pancreas, Patient Affairs, Pediatric, Transplant Administrators, Thoracic, VCA
Regional meeting materials are also posted on Transplant Pro
All of the committee presentations and meeting materials are 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. Meeting materials for today’s meeting are also posted on Transplant Pro.

19. Upcoming: Special Public Comment Period
Tentative: March 27-April 25
Proposal: Guidance on Explaining Risk Related to Use of Increased Risk Donor Organs When Considering Organ Offers
Sponsoring Committee: Ad-hoc Disease Transmission Advisory Committee
Summary: Guidance to inform and facilitate conversations between transplant teams and their patients about increased risk organs
Webinar: April 4: 12:00 pm – 1:00 pm ET
Look for communication from UNOS Regional Administration in late March
Pending approval by the OPTN Executive Committee on March 20th, the Ad-hoc Disease Transmission Advisory Committee plans to hold a special public comment period from March 27 to April 25 for feedback on their guidance document, titled “Guidance on Explaining Risk Related to Use of Increased Risk Donor Organs When Considering Organ Offers.”
Guidance documents must now go out for public comment and follow the same process as policy proposals. This provides transparency and gives members an opportunity to comment on guidance that may affect their practice. A special public comment period is required for this particular guidance document due to the development process with the Joint Societies Steering Committee. Because of the timeline associated with this process, this project was not complete at the start of the current public comment period.
Again, this special public comment period is tentative. Keep an eye out for communications from UNOS after March 20. If this goes forward, Regional Administration will notify the region of a webinar to learn about the proposal, currently slated for April 4th from noon to 1pm ET.

20. Regional and National Data

21. Deceased Donation 2015-2016 U.S. Donors Recovered Organs Recovered
Donors Recovered
Organs Recovered
Organs Transplanted
OTPD
2015
9,079
31,917
27,540
3.033
2016
9,972
35,357
30,490
3.058
% Change
9.8%
10.8%
10.7%
0.80%

22. Deceased Donation 2015-2016 Region 6
Donors Recovered
Organs Recovered
Organs Transplanted
OTPD
2015
360
1,226
1,072
2.978
2016
375
1,315
1,172
3.125
% Change
4.20%
7.30%
9.30%
5.00%

23. Deceased Donors by Type 2007-2016 Region 6
-4%
Total 375

24. Deceased Donors by Type and Region 2016
Still a relatively small percentage of donors recovered in Region 3 are from DCD, while at least 20% of donors in Regions 1, 6, 7, 8, 9, and 10 are DCD donors. Regions 2, 3, 5, and 9 have the greatest percentages of ECDs with over 20.5%

25. Deceased and Living Donors 2007-2016 Region 6

26. Region 6 Living Donors, 2014-2016 2014 2015 2016 LD kidney: 181
LD liver: 0
LD liver: 2

27. Deceased Donor Transplants 2014-2016, U.S.

28. Deceased Donor Transplants 2014-2016 Region 6

29. Framing the day We want feedback from as many attendees as possible
Please actively participate in the regional discussion session!
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 for opposition and any modifications the committee could make

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

31. Thomas E. Starzl, MD PhD (1926-2017)
"Thomas Starzl was many things to many people. He was a pioneer, a legend, a great human, and a great humanitarian. He was a force of nature that swept all those around him into his orbit, challenging those that surrounded him to strive to match his superhuman feats of focus, will and compassion. Nobody who spent time with Thomas Starzl could remain unaffected.”