Consider Primary Transplant Surgeon Requirement- Primary or First Assistant on Transplant Cases

1. Consider Primary Transplant Surgeon Requirement- Primary or First Assistant on Transplant Cases Membership and Professional Standards Committee

2. What problem will the proposal solve? • Primary transplant surgeons for abdominal organs must have performed a set number of transplants and procurements as the “primary surgeon or first assistant” • No specification about the number of cases performed as the primary surgeon • Concerns that abdominal surgeons could qualify with only “first assistant” experience • Responsibilities of a surgical first assistant vary across institutions • May have never performed critical surgical transplant functions expected of a primary transplant surgeon

3. What are the proposed solutions? • Training Pathways • Fellowship program accepts a case towards completion of training = OPTN accepts the case towards key personnel requirements in Bylaws • Abdominal and thoracic primary surgeons • Clinical Experience Pathways • At least 50% of the cases cited in an application must have been performed as the primary surgeon or co-surgeon • Applies to primary kidney, liver, and pancreas transplant surgeons • Bylaws already require a set number of primary surgeon cases for thoracic primary surgeons; this proposal does not impact those requirements

4. Supporting Evidence • Proposal stems directly from recommendations developed by a Joint Societies Working Group (JSWG) • Collaborative effort between the American Society of Transplantation (AST), the American Society of Transplant Surgeons (ASTS), the North American Transplant Coordinators Organization (NATCO), and the MPSC • Training Pathways • Fellows are always noted as an assisting surgeon on hospital billing records • OPTN Bylaws training pathways for primary transplant surgeons already rely on quality training and experience gained during fellowship or residency • Clinical Experience Pathways • Qualifying without some primary surgeon transplant and procurement experience is unreasonable • JSWG agreed that at least half of cases cited should have been performed as primary surgeon • MPSC indicated “co-surgeons” are common in abdominal transplants, and such cases should be viewed as equivalent to cases performed as primary surgeon

5. How will members implement this proposal? • No immediate action required of members • Membership applications received on or after the implementation date will be evaluated in consideration of these new requirements • Primary surgeon applicants applying through a training pathway must provide a copy of their fellowship or residency operative log. • Kidney, liver, and pancreas primary surgeon applicants applying through clinical experience pathways must have performed at least 50% of cases as primary surgeon or co-surgeon.

6. How will the OPTN implement this proposal? • Board consideration- December 2016 • Programming – No • Federal government must approve updates to membership application forms • Implementation- MPSC will evaluate membership applications in consideration of these new requirements • Transition- changes do not impact current primary surgeons • New requirements will be used to evaluate applications received on or after the implementation date

7. Specific topics for feedback • Should the recommendations in this proposal also apply to the primary intestine surgeon Bylaws requirements approved by the OPTN/UNOS Board of Directors in June 2015 that are pending implementation? • Should the recommendations in this proposal also apply to the surgeon requirements of the pediatric component Bylaws approved by the OPTN/UNOS Board of Directors in December 2015 that are pending implementation?

8. Questions? Jeffrey Orlowski, MS, CPTC Committee Chair Jorlowski@lifeshareok.org Chad Waller Committee Liaison chad.waller@unos.org