1. Todd Pesavento, MD Regional Councillor
Region 10 Meeting
Todd Pesavento, MD
Regional Councillor
Welcome to the Fall Region 10 meeting. We know you took time out of your schedule to be here and your attendance is appreciated. I would also like to thank CareDx, Essential Pharmaceutical, and Promethera Biosciences for exhibiting at our meeting today.

2. Meeting Agenda Update from OPTN/UNOS leadership
Regional Discussion Session
Tools You Can Use – UNOS Data Services Portal
Review and discuss 3 public comment proposals
Updates on committee activities: Liver, Membership and Professional Standards, Thoracic, Patient Affairs/Transplant Coordinators Committees
Today’s meeting includes
An update from OPTN/UNOS leadership – Dr. Maryl Johnson, OPTN/UNOS Board Vice-President is here
A regional discussion session –this is an opportunity to have a region-wide discussion about a regional or national issue. Today’s topic is:
Tools You Can Use – UNOS Data Services Portal, from Sarah Taranto Assistant Director of Data Quality and Analytics at UNOS
Discuss and comment on 3 proposed policies – your feedback will be shared with the sponsoring committees
You will also hear updates from the Liver, Membership and Professional Standards, Thoracic, and Patient Affairs/Transplant Coordinators Committees

3. Spring 2019 Regional Meeting Date
Spring 2019 public comment: January 22 – March 22, 2019
proposals will go to the Board for review in June
Mark your calendar! Spring region 10 meeting:
Friday, February 8, 2019 in Toledo, OH
The regional meeting cycle occurs during the public comment cycle. The spring 2019 public comment cycle will begin on January 21 and end March 22. The public comment proposals we discuss today will be reviewed by the Board in December.
The spring regional meeting will be held on Friday February 8, 2019 in Toledo, OH.

4. Region 10 Meeting Attendance
This slide shows our region’s meeting attendance over the last 3 meeting cycles compared to the nation. Region 10 data is in red (% of OPOs and transplant centers that attend the meeting) and national data is in blue. Our goal is to have at least one representative from each OPO, transplant center and histocompatibility lab. If you have suggestions to help engage more members in the meetings, please let me or Ross Walton know.

5. Regional Business As councillor, my role is to:
Oversee regional operations
Serve as the region’s representative to the OPTN/UNOS Board of Directors
Share the region’s comments on public comment proposals
Act in the best interest of the OPTN and UNOS
To best represent the region, I need to hear from you
Welcome members of the Board of Directors
Warm welcome to new attendees at this meeting!
As the regional councillor, I chair the regional meetings and oversee regional operations. Most importantly, I serve as the region’s representative to the Board of Directors. I am the voice of the region at the board meetings, and present the region’s comments on public comment proposals and other OPTN/UNOS matters. As a board member, I make decisions in the best interest of the OPTN/UNOS. In order to do this, I need to hear from you. Speak up at the meeting today, and feel free to or call me with any issues or concerns.
I would like to welcome the Board members in attendance. If you would, please stand and state your position on the Board.
Board members who might attend (all are registered): Walter Herczyk, Danyel Gooch, Randee Bloom, Charles Miller, Marc Schecter, and Maryl Johnson. (Laura DePiero has not registered).
I would also like to welcome the people who are attending our regional meeting for the first time. I know you will find value in today’s meeting and we are glad you are here.

6. OPTN/UNOS Committee Nominations
Early September: call for nominations distributed for committee member openings in July 2019
Nominations accepted for all committee openings: regional representatives, at-large members
Regional representatives: additional responsibility of serving as a liaison between the committee and the region
presenting committee’s work at regional meetings
representing the region’s comments at committee meetings
In early September a call for nominations was sent to all members. You will hear more about this from Maryl Johnson. Committee nomination information is also available at the booklet at your table.
Nominations are being accepted for all committee openings, including regional representatives and at-large members. Both positions essentially have the same responsibilities, with regional representatives having the additional responsibility of being the liaison between the committees and the region. Regional representatives present updates on the committee’s work during regional meetings. They are also responsible for representing the region’s comments at committee meetings.

7. Committee Nominations: Regional Reps
Deadline to submit bio forms for regional representative vacancies is October 19
Regional Nominating Committees meet in November
Select primary and secondary recommendations
Considerations:
Professional experience
Committee needs for subject-specific expertise
Ability to represent regional and national perspectives
Diversity in profession, gender, and race
Compliance with NOTA and Final Rule composition requirements
Past regional engagement
Geographic balance in region
If you would like to be considered for a regional representative position on a committee, submit your bio form by October 19.
The regional nominating committee reviews all nominations received from the region. The committee will meet in November. The committee selection process is based on an individual’s professional experience, the needs of each committee for subject specific expertise, the ability of the candidate to represent the regional and national perspectives, diversity in profession, gender and race, compliance with NOTA and Final Rule composition requirements, participation and engagement at a regional level, and the desire to have representation from as many areas of the region as possible.
FYI – in case you need it, the Nominating Committee membership includes: the regional councillor, Todd Pesavento, associate councillor, Atsushi Yoshida, the immediate past councillor Tim Taber, and two, yet to be determined, representatives from each state in the region.

8. Region 10 Vacancies on Committees (terms begin July 1)
Associate Councillor/Membership & Professional Standards Committee
Operations and Safety Committee
Pediatric Transplantation Committee
Liver and Intestinal Organ Transplantation Committee
All committee terms are 3 years, with the exception of the MPSC that remains a 2 year term. Here is a list of the regional representative vacancies.

9. Associate Councillor/Councillor-Elect
Regional representative to the MPSC for a 2-year term ( )
Councillor position for additional 2 years
Serving as a liaison between the region and the OPTN/UNOS Board of Directors (Board member: )
Chair regional meetings, manages regional operations, chairs the regional nominating committee
Responsibilities and time commitment are significant
Each region’s Associate Councillor serves as the regional representative to the Membership and Professional Standards Committee for a 2-year term. This individual serves an additional 2 year term as the regional councillor.
MPSC Responsibilities:
serves as the regional representative to the MPSC and stands in for the Regional Councillor as necessary
MPSC meets three times a year for three day meetings, usually in Chicago
MPSC has two standing subcommittees and each committee member is assigned to one
The subcommittees and full committee meet by conference call as necessary.  Committee members are assigned to additional subcommittees and workgroups during their term.  Committee members are also expected to participate in the review of new program applications and key personnel changes, which require 2-4 hours of work per week.
The Associate Councillor moves into the Councillor role for an additional 2 years. The Councillor is responsible for chairing regional meetings, leading regional nominating committee meetings, handling regional business, making decisions on behalf of the region, and serving on the OPTN/UNOS Board of Directors.
Both of these roles come with a lot of responsibility and require a significant time commitment.

10. Associate Councillor/Councillor-Elect
Selection process
Same considerations as committee openings, PLUS:
Past OPTN committee experience
Board of Directors needs for diversity in profession, race, and gender
Ability to take an organizational view
Regional guidelines, if applicable
Election process
Nomination period closes October 19
Regional nominating committee selects the slate
Ballot sent to regional voting representatives
The selection process for the Associate Councillor/Councillor-Elect positions takes into consideration the same criteria as committee openings, but also includes past committee experience, the need for diversity in profession, race, and gender on the Board of Directors, and individuals who have the ability to take an organizational view.
Board members have legal and fiduciary duties.  The Board sets the tone and direction for the organization and Board members act as trustees of OPTN and UNOS assets.  As stewards of the organization and public trust, Board members must act for the good of the OPTN and UNOS, rather than for the benefit of themselves. 
When we say that we want someone who can take an organizational view, we mean that it is important to understand these legal and fiduciary duties that come with service on the Board.
If you are interested in serving the region in this capacity, please submit your bio form online by October 19. The regional nominating committee will develop the ballot for the election and the ballot will be distributed to the voting representatives in the region.

11. What are we here to do today?
Primary purpose: gather feedback from everyone, which requires your participation! We want you to…
Ask questions
Share your comments
Vote (regional voting members)
Network with colleagues and catch up
Share information and learn from one another
We want to remind you why we are here today. The primary reason is to get feedback from everyone here. Which means we want you to actively participate today. We want you to ask questions and share your comments. Regional voting members will vote so that we know the sentiment of the region.
We are also hear to network with colleagues, share information and learn from one another.

12. Polling Polling – uses Poll Everywhere (text message based)
Provides helpful feedback from attendees about the meeting and UNOS
All attendees can participate

13. Polling – Audience Feedback
unos1
22333 D
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Step 1:
Step 2:
In an effort to collect more feedback from attendees, we are using Poll Everywhere to ask questions throughout the meeting. Participating is easy!
First, take out your cell phones and text “unos1” to the number I’m going to pause here a moment to allow you to get out your phones.
As we go through the meeting, we will ask for your feedback on specific questions related to your experience at the regional meeting.
As each question comes up, you will just need to text your response to the same number – Let’s get started with a test question so we can try it out.

14. Test polling question
As of June 2018, organs were recovered from over 8,000 donors and a total of 17,935 organ transplants were performed A: True: Yay, that’s awesome! B: True: Yep, great work!
Remember to text your response (A or B) to

15. Polling Question
What was the primary way you prepared to discuss the proposals on the agenda? A) Listened to a webinar (live or recorded) B) Read public comment proposal(s)/reviewed presentations online C) Discussed with my colleagues D) Waited to hear the presentations today

16. Polling Question
How familiar are you with the process UNOS uses for creating or changing OPTN policies? A) Familiar B) Somewhat familiar C) Not sure

17. How are policies developed?
To get us started, I’d like to focus on our primary purpose – getting feedback on public comment proposals.
This image on the slide is a high-level overview of the policy development process. This is also included in the meeting booklet and I would ask you to take a look at that document as I explain the chart.
We are in section 6 - public comment.
The items to the right of section 6 list everything that occurs before a proposal can even be presented at a regional meeting. Everything starts with an idea or a problem to solve. There are layers of analysis and approvals built in to ensure that proposals have been thoughtfully reviewed and considered by the committees.
All of the items to the left explain what happens after we leave this meeting and public comment ends. Section 7 – pending Board approval is a really important stage even though it looks like a short phase on this chart. At that time, the committees are reviewing all feedback collected, considering post-public comment changes, and making their final recommendations to the Board for consideration.
The Board will receive all feedback collected during public comment, review the committee’s final recommendations, and vote on whether to adopt the proposed changes. Your feedback influences changes to proposals before they are sent to the Board and it provides me with information to better represent your viewpoints during the Board meeting.
The Board looks at feedback from all regions, individuals, and other groups and determines what is best for the OPTN as a whole.

18. How will we provide feedback?
Thorough discussion on all proposals
Answer specific questions the committee wants us to consider
Talk about merits of the proposals
Suggest improvements
Your feedback is key to develop policies and bylaws that are comprehensive and able to be operationalized by the transplantation and donation community.
The goal today is have a thorough discussion on each proposal. We want to know why you support a proposal and if you oppose a proposal tell us why. It is more important to know why a region votes one way or another versus the actual vote tally. The committee can’t make changes unless feedback is provided by the community.
Today, we will ask you specific questions about each proposal. We will also want to talk about the merits of each proposals and suggest ways to make them better. And, tell us what you don’t think is good about a proposal and why.

19. Regional Sentiment
Voting is another form of expressing your viewpoint about a proposal, it helps us quantify the feedback
We don’t follow a specific order for voting
Vote on the proposal as is;
Vote on the proposal as is and suggest changes;
Identify changes and then vote
Important that you understand how to express your opinion and what we are voting on vs. following a specific order
Comments and votes are our best effort to communicate regional sentiment
We do want to know the region’s sentiment about proposals; whether the voting members support or oppose a proposal because it helps us quantify the feedback.
We don’t follow a specific order for voting, so we don’t follow Robert’s Rules. We can vote on a proposal as written, vote on a proposal as is and suggest changes, sometimes in the form of an amendment, or we can identify changes and then vote. The amendment process is one way committees have found helpful to learn what revisions to the proposal would achieve broader consensus.
It is more important that you know what we are voting on versus following a specific order for voting. The feedback we get today along with the vote tally is our best effort to collect regional sentiment on public comment proposals.

20. Public Comment Opportunities
Contact Regional Representatives
List is located in the meeting booklet and on Transplant Pro: select the community tab, and then “regions”
Submit public comment online
OPTN website:
Public comment closes October 3
If you have feedback on any of the public comment proposals, you have a few ways to provide it.
You can contact our region’s representative to 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.

21. What is new today? Electronic Voting
Voting reps received instructions at the registration desk
Goal: Better understanding of perspectives in the regional vote
All regions are going to be using electronic voting this fall.
Feedback from past meetings has shown interest in moving to electronic voting.
Using electronic voting will help the committees better understand the perspectives in the regional vote - OPOs vs. transplant centers vs. histo labs

22. What’s new today? Enhanced Voting Scale
Abstain/ Neutral
Strongly Oppose
Oppose
Support
Strongly Support
We are also changing the type of responses that will be available for voting.
Past option: support, oppose, abstain
New scale: “strongly support, support, oppose, strongly oppose or abstain/neutral”
Changing to this new scale will help the committees and board understand how strongly the transplant community feels about a particular proposal.
The combination of electronic voting and the enhanced voting scale will allow us to make the following improvements:
obtain granular demographic data from public comment participants
Look at participation levels among various subgroups within the transplant community
identify participation gaps from underrepresented groups
perform outreach and engage with communities not represented in public comment
understand at a deeper level how strongly the community feels about a proposal
compare sentiment across regions and member types

23. Voting Reps – Let’s Practice!
Follow instructions provided at registration
Raise your hand if you need assistance
Voting – uses Turning Point (web-based)
Collects regional vote on public comment proposals
Only used by voting reps
Test question for voting members
We are going to practice using the voting software.

24. Regional Meeting Agenda: Non-Discussion
Includes proposals anticipated to be:
less 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 less 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 to give 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 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.

25. Non-Discussion Proposals: Vote You have the option to abstain from voting if you haven’t reviewed the proposals
Change to Hospital-Based OPO Voting Privileges (Membership & Professional Standards Committee)
Changes to Islet Bylaws (Pancreas Committee)
Guidance on Pediatric Transplant Recipient Transition and Transfer (Pediatric Committee)
This slide includes a list of the proposals on the non-discussion agenda that we will vote on today. **Read the title of each proposal**
The plan is to take one vote on both 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 both items: strongly support, support, oppose, strongly oppose, abstain/neutral.
If hands are raised: vote on each proposal separately: strongly support, support, oppose, strongly oppose, abstain/neutral.

26. Regional Meeting Materials – online!
Today’s presentations are posted on Transplant Pro
Make sure to review the non-discussion proposals and committee updates not presented today
Minority Affairs, OPO, TCC, Pediatric, Transplant Administrators, 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.

27. Framing the Day We want feedback from as many attendees as possible
To manage the discussion on each proposal, please limit your comments to new comments, points that haven’t been raised
To be sure your comments and questions are heard, please use microphones

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

30. Polling question (after lunch)
In the past 12 months, how many of the following activities have you participated in?
Listened to a public comment webinar, submitted a public comment, served on a committee/board, accessed educational training from UNOS Connect, contacted UNOS staff, accessed OPTN/UNOS resources
A) 0 activities
B) 1-2 activities C) 3-4 activities
D) All

31. Polling Question (after lunch)
What is the primary way you communicate your opinion on proposed changes to OPTN policy? A) Speak up/vote at a regional meeting B) Submit public comment online C) Comment during a webinar D) Participate on an OPTN/UNOS Committee or Board E) Not planning to comment on the proposed changes

32. Polling Question
Do you believe sharing your opinion influences changes to public comment proposals?
Yes no

33. Polling Question
After attending today’s Regional Meeting, do you plan to submit a public comment on the OPTN website?
Yes No