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Liver and Intestinal Organ Transplantation Committee Spring 2014

Spring 2014 committee addresses lack of defined criteria for intestine transplant programs, setting minimum qualifications for surgeons and physicians without limiting access or hindering new programs. Includes support evidence, experience pathways, and transition plans.

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Liver and Intestinal Organ Transplantation Committee Spring 2014

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  1. Proposed Membership and Personnel Requirements for OPTN Designation & Approval of Intestine Transplant Programs Liver and Intestinal Organ Transplantation Committee Spring 2014

  2. Problem Statement • No OPTN/UNOS requirements exist regarding who may perform intestine transplants and care for intestine transplant recipients • Currently, any transplant program that is approved to perform liver transplants can perform intestinal transplants upon submitting a written request to UNOS membership department

  3. Goals of the Proposal • Define a designated intestine transplant program • Establish minimum qualifications for primary intestine transplant surgeons and physicians • Done without compromising quality or restricting new program formation

  4. Additional Background • Prior Proposal: August 2006 • Not well-supported, withdrawn • Concerns from 2006: • Many well-qualified programs would not meet requirements • Did not contain a transition plan for existing programs

  5. Additional Background • Current Proposal • Lower thresholds • Full approval and conditional approval pathways

  6. Supporting Evidence • Low-volume procedure with most programs performing fewer than 5 IN or LI-IN transplants in 2012 • Thresholds not derived from statistical analyses • Represent level of experience to set minimal standards without restricting access or new program development • Similar to initial thresholds for other organs

  7. Summary ofProposed Bylaws

  8. Primary Surgeon Experience Pathways

  9. Primary Physician Experience Pathways

  10. Provision for Combined Adult/Ped Programs • Primary pediatric IN transplant physician can function as primary adult IN transplant physician if an adult gastroenterologist is also involved in the care (if in same program) • If no qualified pediatrician on staff: • Adult IN transplant physician can function as primary Pediatric IN transplant physician pediatric if a gastroenterologist involved in the care • Programs serving predominantly pediatric patients should have a board certified pediatrician who meets the criteria for primary IN transplant physician

  11. Centers Performing at Least One Intestine Transplant 2009-2013 (n = 26 “active” out of 41 registered IN programs)

  12. What Members will Need to Do • On a given date ALL current intestine transplant program designations will terminate • At least 120 days before the termination date an intestinal transplant program application will be available • Members must submit an application and receive approval by the termination date in order to perform intestine transplants

  13. Questions? • David C. Mulligan, MD Committee Chair david.mulligan@yale.edu • Name Region # Representative Email • Ann Harper Committee Liaison ann.harper@unos.org

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