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Solving Geographic Disparity: Liver Distribution Update

This update discusses the principles and solutions related to geographic disparity and liver distribution in the OPTN. It includes an update on the COIIN initial cohort, liver distribution options, and the Liver Committee's work plan. It also provides information on the 2017 Board of Directors election and a call for nominations for the 2018-2019 Board of Directors. Additionally, it mentions UNOS Labs' efforts in bringing behavioral science to the matching system and the new data portal visualizations and reports.

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Solving Geographic Disparity: Liver Distribution Update

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  1. UNOS UpdateRegion 2 Stuart Sweet, MD, PhD OPTN/UNOS President March 17, 2017

  2. COIIN

  3. COIIN initial cohort 14 OPO partners

  4. COIIN year 2 timeline

  5. Liver Distribution Update

  6. Miami Meeting Because solving this problem is a responsibility that comes with the leadership role our community has been given in OPTN: Attendees with diverse viewpoints discussed principles related to geographic disparity and liver distribution: • Supply/Demand Metrics • Disparity, Outcome and Access Metrics • Logistics, Finances, Post-Implementation Monitoring • Solutions and Implementation Strategies 5 8 2 3 7 1 4 6

  7. Supply / Demand Metrics • Important to Agree on the supply/demand metrics used as inputs to potential solutions • Recommended choosing metrics free of influence from DSA performance (supply) and center listing practices (demand) • Recommended the Liver/Intestine Committee explore data available from the CDC / National Center for Health Statistics for this purpose • The these metrics will then be used to generate new supply/demand ratio “heat maps” demonstrating the geographic variability by DSA/Region.

  8. Liver Distribution Options The Liver/Intestine Committee has asked the SRTR to model the following options: • Concentric Circles • Sharing to all transplant centers within a fixed distance from the donor hospital • Share M/P 29+, 500 mi circles, 3 M/P Proximity points in 150 mi circle or DSA • 8 Districts • Optimized redistricting • Share M/P 29+, 3 M/P Proximity points in 150 mi circle or DSA • Neighborhoods • Optimized DSA based sharing • Share M/P 29+, 3 M/P Proximity points in 150 mi circle or DSA • The Committee may consider a Seth Karp / Will Chapman directed sharing idea if developed in a suitable time frame 5 8 2 3 7 1 4 6

  9. Liver Committee Work Plan

  10. 2017 Board of Directors Election • 2017 President Yolanda Becker • Vice president/president-elect Sue Dunn • Treasurer David Reich • Minority Transplant Rep Akinlolu Ojo • Patient and Donor Affairs Representatives: • William Freeman • Macey Henderson • Tara Storch

  11. Call for nominations: 2018-2019 Board of Directors

  12. Goals for 2018-2019 Board Improve diversity for a better overall balance in: • skill sets and professions • minority and gender representation • patient/donor backgrounds

  13. Positions Open on 2018-2019 Board • Vice President/President-Elect • Vice President of Patient Donor Affairs • Secretary • Patient/Donor Affairs Reps (4) • At-Large MDs • Specialties needed: pediatrics, thoracic, transplant medicine specialties (nephrology, hepatology, etc) • General At-Large • Committee specifically requests professionals in transplant administration and health care finance

  14. Call for nominations: 2018-2019 Board of Directors • Now-August 2017 Individuals submit interest form • After August 1, 2017 Nominating Committee begins reviewing interest forms • December 2017 Nominating Committee recommends to Board a final slate of nominees for approval • February/March 2018 Board elected by vote of members through national electronic ballot • July 1, 2018 New Board members begin term

  15. UNOS Labs: bringing behavioral science to the matching system Source: www.irrationallabs.org

  16. Source: www.irrationallabs.org

  17. UNOS Labs Mock Offer Simulation System • Web-based application designed for experimentation • Goal is to have similar look, feel, and content as current DonorNet • Pursuing a “near real-world” offer decision-making environment • Mobile phone and PC friendly • Prototype system under development Would you be interested in contributing to this science by receiving and responding to mock organ offers? email unos.labs@unos.org

  18. Data Portal Visualizations and Reports • Launched a new, secure data portal within UNet in December 2015. • Members are able to access automated reports updated at least monthly. • Report on Organ Offers released in December 2015 in both Tableau and Excel format. Updated weekly. • Other reports currently in “My Data Files” includes ABO Validation and Outcomes of Transplanted Organs. • New reports coming soon: • Data submission compliance (CMS and OPTN) • US waiting list by zip code of residence. • Donors recovered with fields included in SRTR OPO reports. Report on Organ Offers

  19. NEW UNOS Benchmark Report

  20. UNOS Data and Quality services • Customized OPO local utilization dashboards • Market impact analyses for OPO/transplant centers considering organizational changes • Customized, mini-primers • Transplant data boot camp trainings • Data coordinating center contracts for clinical trials • Registry development and management for regional/national collaboratives • International consulting/training seminars • Comprehensive transplant center activity dashboards • Transplant center service line analytics consulting

  21. 2016 Financial Results • Total FY2016 OPTN expenses totaled $45,995,581 • Registration fees provided 88.5% of funding. • Federal appropriations 11.5% of funding 2016 Actual 2016 Budget 2015 Actual 54,109 56,066 53,417 1,957 registrations ($1.6 million) below budget

  22. 2016 OPTN Expenses

  23. FY 2017 finances • Registration Fee increased from $957 to $979

  24. FY 2017 finances Looking at year over year changes, there has been a steady decline in kidney listings with <1 year of dialysis, but in 2016, there was a stark shift in additions with 1-<3 years of dialysis. Indicative of possible “rebound” or “catch-up”? Decreasing since 2013 Post-KAS Increase Recent shift to increase Note: Bar represents percent change from previous year, while number represents number of registrations during calendar year.

  25. UNOS UpdateRegion 2 Stuart Sweet, MD, PhD OPTN/UNOS President March 17, 2017

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