1. Pediatric Transplantation Committee
Spring 2018

2. Board Approved Projects
Summary
Implementation Status
Pediatric Transplantation Training & Experience
Established training and experience requirements for key personnel at pediatric heart, liver, and kidney transplant programs
Anticipated application due date no sooner than Q2 2019
Full implementation TBD
The Board passed the pediatric transplantation training and experience bylaws proposal at the December 2015 Board meeting. The delayed implementation gives pediatric transplant programs enough time to either ensure their key personnel are qualified, or recruit a qualified primary transplant physician or surgeon. Any program that has listed at least one pediatric candidate in the last five years will receive an application. Applications from your transplant program are targeted for Q Full implementation of the training and experience requirements will follow. The MPSC will review application submitted to the OPTN during the months that follow. The OPTN will notify the transplant hospitals well before they send them the applications.
You can find additional details in the policy notice - (p 163)

3. Board Approved Projects
Summary
Implementation Status
Revise Pediatric Emergency Membership Exception
Outlines the requirements for an adult heart or liver to register a candidate less than 18 years old.
No sooner than 2019
In December 2017, the Board approved amendments to the Pediatric Emergency Membership exceptions for heart and liver transplant programs. These exceptions outline when an adult heart or liver transplant program can register a candidate less than 18 years old.
Implementation will be in 2019 in tandem with the detailed training and experience requirements for key personnel at pediatric transplant programs. The OPTN will notify transplant hospitals well before they send them the applications.

4. Future Projects
Project
Summary
Status
Tracking Pediatric Transplant Outcomes Following Transition to Adult Care
Inconsistent transfer practices for pediatric transplant recipients to adult programs for post-transplant care
Project will create guidance for recipient follow-up after transfer
Public comment target - July 2018
Pediatric heart, lung, and liver transplant recipients are often transferred to adult transplant programs for post-transplant care when the recipients turn 18 years old. This transition practice is inconsistent for pediatric kidney transplant recipients. Payers, and to some degree a recipient's geographic location, influence where a pediatric kidney recipient receives post transplant follow-up care. If this follow-up care is performed by a non-OPTN affiliated nephrologist, the transplanting hospital often reports this recipient as "lost to follow-up" to the OPTN due to the difficulty obtaining information or the inability to contact the recipient (or provider). This "lost to follow-up" classification for pediatric recipients negatively impacts true understanding of graft and patient survival. Long term follow-up data is vital to understanding post-transplant survival.
The Pediatric Committee is developing guidance for transplant programs on effective practices for following a recipient after he/she is transferred to an adult transplant program. The target for public comment is July 2018.

5. Future Projects
Project
Summary
Status
Reduce Pediatric Liver Waitlist Mortality
Examining issues of extended waiting times and waiting list mortality of very young pediatric liver candidates. Identified solution requires simulation modeling by SRTR
Pending review by OPTN/UNOS Executive Committee
Under review
A Subcommittee of pediatric liver transplant specialists have examined the problems of extended waiting times and waiting list mortality facing pediatric liver transplant candidates, especially very young candidates. This proposal is in the early stages of development and discussions are ongoing with members of the OPTN/UNOS Liver and Intestine Committee. The Subcommittee feels one potential solution is to move liver candidates less than 18 years old higher in the liver allocation sequence and prioritize those pediatric candidates most at risk of death. SRTR will need to perform Liver Simulation Allocation Modeling (LSAM) to assess what approach may be optimal.
This project was approved by the OPTN/UNOS Policy Oversight Committee in November A review by the OPTN/UNOS Executive Committee is pending in March 2018.

6. Questions?
William Mahle, M.D. Committee Chair Christopher. L. Wholley, M.S.A. Committee Liaison