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Update on OPTN Regional Review Project

eye iconAt a glance

Current policy

The Organ Procurement and Transplantation Network (OPTN) Regions were created from groupings of Donation Service Areas (DSAs) to help manage the national organ transplant network. These regional boundaries were based on patient referral and organ sharing patterns when they were created in 1986. Each region has a representative serving on the OPTN Board of Directors and on most committees to ensure thorough consideration of how transplant policy may affect people and institutions in the United States.

The OPTN is seeking feedback on how regions, or a different model, can best fulfill the functions below for OPTN members and stakeholders. The main functions of the OPTN Regions are:

  • Representation: to elect regional representatives to the OPTN Board of Directors and OPTN Committees
  • Communication and feedback: to gather sentiment on policy proposals
  • Operations: to include discussions about shared operations and effective practice
  • Data analysis: to describe geographic differences in transplant data at the Regional level

The OPTN and the broader transplant community have significantly evolved over the past 25 years. The purpose of the OPTN Regional Review project is to optimize OPTN governance and operational effectiveness by evaluating the role of regions. This request for feedback aims to gather input from the transplant community to determine whether changes to the OPTN structure should be pursued via a future policy proposal.

Share your thoughts via the Summer 2021 OPTN regional review feedback form.

Supporting media

Presentation

View presentation

Requested feedback

An independent consulting group performed a review and analysis of the OPTN regional structures and processes. This request for feedback includes their early findings and three proposed models for a new OPTN structure. These models should be viewed as a list of ideas, rather than a limited set of recommendations.

  • Model 1: Communities of Common Interest
    • Regions would be replaced with alike communities, such as non-academic transplant centers or rural organ procurement organizations (OPOs)
    • Policy debate at these community meetings would be focused on policies of greatest interest to their group
    • Communities would elect Councilors, who would hold seats on the Board
  • Model 2: Repurposed Regions
    • Regional boundaries would be redrawn based on population or OPTN membership count
    • Policy debate would occur at a national meeting
    • Regions would elect regional leaders to form a Regional Advisory Body to the Board
  • Model 3: Hybrid Cohorts
    • Regions would continue to be based on geography for transplant centers, OPOs, and histocompatibility labs
    • Patients and donor families would be grouped into national cohorts
    • Boundaries of regions would be redrawn to better reflect new organ allocation rules and practices

Considerations

  • What is the optimal governance structure to best perform OPTN functions?
  • How should the OPTN organize members into smaller forums?
  • How should the OPTN ensure members have a voice in policy?
  • How can Regions, or an alternate construct, serve members and enable OPTN’s strategic goals?
  • What role should geography play in the OPTN structure and functions?

Anticipated impact

  • What it's expected to do
    • Your feedback will aid the OPTN Board of Directors in deciding whether to propose changes to the OPTN structure, and if so, what a new OPTN structure should look like
  • What it won't do
    • This paper is not a proposed policy change, but will help inform future policy development

Themes

  • Allocation equity
  • Community engagement
  • Policy participation

Terms to know

  • Donation Service Area (DSA): The geographic area designated by CMS that is served by one organ procurement organization (OPO), one or more transplant centers, and one or more donor hospitals. 
  • Organ Procurement Organization (OPO): Non-profit organization responsible for the procurement of organs for transplantation.
  • Policy Oversight Committee (POC): The Committee advises the Board of Directors and Executive committee in developing strategic policy priorities, prioritizing and coordinating policy and committee projects, and evaluating policy and committee proposals prior to public comment.
  • Regions: For the administration of organ allocation and appropriate geographic representation within the OPTN policy structure, the membership is divided into 11 geographic regions.

Click here to search the OPTN glossary

Provide feedback

eye iconComments

OPTN Organ Procurement Organizations Committee (OPO) | 09/24/2021

The OPO Committee appreciates the opportunity to provide feedback on the Executive Committee’s request for feedback on the OPTN Regional Review project and provides the following comments: One member remarked that regional meetings vary region to region, and that it would be nice to maintain current regional relationships, and maximize relationships with new key partners (OPOs and transplant centers) in broader sharing who are outside of the administrative region. Another member agreed, sharing that many OPOs have already begun to reach out to transplant centers that they have begun to share more organs with in broader sharing. The member added that a hybrid model built to optimize these allocation relationships in a more formal way would work best. One member agreed, noting that there has been a fundamental change in how procurement and allocation are organized, and redistributing those relationships within the broader sharing boundaries would be worthwhile.

Region 1 | 09/24/2021

A comment was submitted saying the OPTN has an opportunity for the makeup of the Board to be representative of the community with less constant re-education and change while allowing organ specific committee inputs on policy recommendations and maintaining diversity and inclusion. The comment also said that keeping the relationships built with existing regions could be modified to include the centers and OPOs that newer methods of allocation have created. Another member submitted a comment that there is a need to separate grouping based on geography for operational or policy implementation purposes versus for policy review and representation on governance. An attendee commented that when kidney allocation changes, OPOs in New England came together to discuss best practices and consider how they could work most efficient and effectively together, and that when our goals are aligned it adds to discussion and makes a more productive and collaborative environment.

OPTN Pediatric Transplantation Committee | 09/24/2021

The Pediatric Committee thanks the OPTN Executive Committee for the opportunity to review their OPTN Regional Review Project update. The Committee provides the following feedback: The Committee emphasized the importance of geography in regards to issues that affect patients. The Committee was concerned with the communities of interest model, especially from the pediatric perspective, since it would group members with the same opinions together instead of encouraging discussions among members with different priorities or interests. The Committee stated that these diverse groups are where discussions arise about the impact non-pediatric policies have on children, which are crucial for the work of the Committee. In regards to whether the current regional structure and regional meetings are working, Committee members agreed that they felt there was adequate pediatric representation and that the virtual format has been helpful in allowing more people to share their opinions.

OPTN Pancreas Transplantation Committee | 09/24/2021

The Pancreas Committee thanks the OPTN Executive Committee for the opportunity to review their public comment proposal. The Committee provides the following feedback: Members agreed that it is important to have different perspectives convening for discussions at the regional level and that they would be worried about creating silos if the regional structure switched to the communities of interest model. A member noted that keeping the geographical component is important from the patient perspective, since patients in the same area will probably be experiencing similar issues. Members suggested that the regional structure should be retained, although it could be resized since transplant volume at certain centers have changed and there are new centers available. Members also noted that hosting the regional meetings in different locations from year to year, instead of staying in the one regional location, would allow more members to attend and share their perspective.

Region 6 | 09/23/2021

An attendee noted that historically, changes among regions have been mainly related to organ allocation, so it may be challenging to realign regions for administrative purposes. The same attendee added the current structure has always worked well for regional meetings.

Region 8 | 09/22/2021

Region 8 supports the Regional Review Project and the opportunity to provide feedback on it, with specific suggestions below. A member pointed out that the challenge will be what to do with the Board of Directors and it’s structure (i.e. number of board members, and representation). A member stated that his institution favors maintenance of a regional structure, with participation of all stakeholders at the same meeting. There is a need to make all stakeholders feel more welcome to participate, but we believe that some groups would feel even more marginalized if they met independently and in the absence of relevant data from transplant experts. Further, the member stated that his institution is pleased that the consulting group recognized the distinct disconnect between what the region believes the function of its representative is (to represent the sentiment of the region at Board of Directors votes) versus the actual fiduciary responsibility of the regional representative to the OPTN/UNOS at Board votes. Further, he suggested that the regional representative ought to more accurately represent the "will" of the region so that the function of "representation" actually carries weight. At the very least, this distinction should be made clearly known at every regional meeting (that the regional representative is not bound to vote in the direction the region has voted). Lastly, the members’ institution believes that, while it is aware the size of the UNOS/OPTN BOD is somewhat dictated by regulation, its size is too unwieldy to be functional by most standard business measures. A member stated that his institution generally supports the reduction in the size of the OPTN Board of Directors. Because transplantation is a multidisciplinary effort, we recommend caution in regrouping regions primarily based on cohorts. We recommend caution with the proposal to replace the POC (currently made up of committee vice-chairs) with a cohort based Policy Council as on the surface it isn't clear that such a structure could replicate the current functions of that committee. Another member stated that currently Region 8 is not indicative of organ allocation practices and that it would be nice to have the opportunity to formalize these newer networks. The member further stated the importance of ensuring the OPTN Board of Directors size is not overwhelming but representative of all stakeholders. A member appreciated the Regional Review project being taken on and having input in the project. The member stated that representation from Region 8 has been a success for his transplant program and that using this platform to discuss policy proposals, sharing best practices, and data has been fruitful. It would be important to ensure the data comparisons used today for transplant center to region have a similar representation in a new system. In addition, because there is so much variability of transplant programs, types, size within the region that allows opportunity for competing views in discussions, eliminating this and moving towards a grouping of common roles or professions may eliminate robust discussions of competing views.

IOWA DONOR NETWORK | 09/22/2021

As a past Regional Councilor, I valued the opportunity to come to a Regional Meeting (in person or online) to hear the latest policy proposals and have them explained, perhaps better than in written form, and to hear diverging opinions. That, I think, is the most important part of the meeting; the opportunity to get up and express opinions whether pro or con. I'm not sure that the vote/sentiment of the Region really mattered that much. When it came down to me casting my vote at the board meeting, I had the fiduciary duty to vote for what I thought was best for the organization. I based my opinion on what I heard, learned and read about each issue and the Regional meeting was a good place to get that input. I also value learning about what it is in the, "hopper" so to speak. What are the committees thinking about and dealing with that has not yet come to the policy proposal stage. The Regional meeting is also a good opportunity to learn the Federal perspective and to get an update on UNOS organizational and administrative issues. I also, very much value the input from the patients, donors and donor families. The Regional meeting is more informal than a board meeting and I found that those representatives were more likely to speak in that environment. In my view, the jury is still out on how organ allocation will change all of this. While we are in Region 8, most of our organs have been going to Region 7. If the Regional Meeting is designed to help us work more effectively with our organ sharing partners, we should probably wait with a re-design of the regions until we have put Continuous Distribution in place for all of the organ systems AND allowed enough time for new organ sharing relationships to emerge.

Steven Potter | 09/19/2021

I favor maintaining the current Regional structure. The current system continues to be effective. It provides a modicum of representation from the regions and a mechanism for diverse community voices to be heard and to be effective in policy development. The regions have been effective drivers of change, but have also been extremely valuable to the OPTN as crucibles for policy development. They have provided, at times probably to the chagrin of the OPTN, diverse views and a "reality check" to some of the more problematic policy proposals that have come for community comment. Regional representation on the Board and Committees have been extremely valuable for the OPTN and, in turn, for membership. The deliberative process at the regional level has ultimately protected both the interests of the OPTN and of the greater transplant community. Please maintain the current regionals system rather than expend resources changing a part of the system that is not broken. As a community, lets instead focus all energy on our shared passion and strategic goal of increasing access to transplantation nationwide.

OPTN Histocompatibility Committee | 09/16/2021

The OPTN Histocompatibility Committee appreciates the opportunity to comment on the OPTN Regional Review Project. Members emphasized the need to maintain an interdisciplinary forum for policy development in order to ensure stakeholders are properly engaged, and that the current regional system helps foster more productive discussions due to differing viewpoints. One member posed that entirely discarding geography wouldn’t be appropriate, especially in regards to programs in close proximity more frequently working with other, and that it may be more appropriate to change the regional structure to reflect changes in populations. A member posed that there should be an effort to incorporate plain language explanations for proposed policies in order to be more accessible to the patient community and to the and general public. A member asked that the Executive Committee consider representation for histocompatibility labs who are part of a transplant hospital, and that currently they don’t have their own voice.

Denise Neal, RN, BSN, BS, CPTC | 09/15/2021

As a previous and now current member of an OPTN Committee, I think consideration should be given to each of the mentioned entities. Working interactions, professions, proximity, and common roles are all very important within a group. Each brings their own important point of view. A group of representatives with common roles, regardless of their proximity, will be able to evaluate an issue and develop a potential plan for resolution. Given the size and diversity of the United States, proximity should be considered so that the needs of all stakeholders are addressed. Regarding regional groupings, I believe the size and shapes of the regions should be revisited. Region 3 is a good example; Puerto Rico can have very different issues than Arkansas. And Georgia may be able to relate better on issues with Tennessee and North Carolina. Alaska, Hawaii, and Puerto Rico struggle with issues that the contiguous states do not. They may benefit from a grouping together that allows them to work on issues related to the difficulty of their location and proximity to the 48 conjoined states. I am for keeping geographical regions, but feel that it is time that they are amended to better serve its members. I feel the most important function of the membership groups is the evaluation, modification, and finalization of policy proposals. This is so important because it is from here that the Board receives opinions and feedback from specialty committees, regions, transplant centers, and OPOs. This, along with public comments from independent stakeholders, is valuable information considered by the Board when making the final decision on a policy proposal.

Region 7 | 09/15/2021

Comments: One attendee stated that regions are helpful in allowing broader sentiment collection, as well as a way to develop a "bench" of individuals who move up to committees and leadership. Regions also provide a larger forum to ensure that the full demographic of transplant is represented - large/small program, across organs, academic/private, health professionals, donors, recipients, and etc. An attendee suggested improvements to the regional representative process to make certain, that the best qualified candidates are available to committees. Another representative added that regions are a really important mechanism for receiving information and being able to provide feedback to the OPTN. It allows members to hear what the issues are for the other organs. During the meeting, there was continued discussion on regional representation and suggestion from one attendee on grouping pediatric and adult separately. Another attendee recommended grouping larger and smaller centers separately. One attendee commented that regional meetings allow discussion across organs, different size centers, and between pediatric and adult programs that may not always occur in organ-specific committees. Most attendees agreed that regions are important but may need to consider rebalancing based on shifts in population.

OPTN Heart Transplantation Committee | 09/15/2021

The Heart Transplantation Committee appreciates the opportunity to provide input on the Executive Committee’s request for feedback document Update on Regional Review Project. The Committee supports this initiative overall. The members did not express a consensus for any specific option identified in the document, but individual members did share their feedback about some of the options. A member commented that they support the idea of the Communities of Common Interest model but noted there are practice patterns tied to regions as well, noting that rural programs face different challenges than urban programs. Another member commented that geography may become less important as continuous distribution is implemented and it will be important to promote communication among all members as opposed to just members within a region. The members value the interactions with various member types (transplant programs, organ procurement organization, etc.) and believe that separating these member types into groups may create silos, potentially decreasing cooperation or cross functional understanding. The members support the structure of regional meetings to facilitate member communication but acknowledge that the way the regions are drawn are arbitrary at this point in time. A member also commented that although the Board of Directors may be large, it does have broad representation.

OPTN Operations & Safety Committee | 09/15/2021

The Operations and Safety Committee thanks the OPTN Executive Committee for their efforts on the OPTN Regional Review Project. The Committee suggested that the function of the groups should be determined before deciding on a new regional structure. The Committee supported keeping aspects of the current regional structure. The Committee noted the benefit of groups based on regions, given differences among regions such as geography, logistical and travel challenges, and population density and makeup. The Committee noted that groupings based on populations is more beneficial than groupings based strictly on state lines. Additionally, the Committee noted that the current regional structure supports the already established relationships within the transplant community. The Committee suggested the regional review take into consideration organ procurement organization (OPO) regions and the new OPO metrics. The Committee noted that the Centers for Medicaid and Medicare Services (CMS) directive for OPOs to influence transplantation rates has led to relationship development within regions to increase utilization, and a potential change to the regional structure would undo a lot of that collaborative work. The Committee also suggested a concept paper that is easily accessible and digestible as it is important for the transplant patient community to understand OPTN regions and their potential impact.

Region 9 | 09/14/2021

One member suggested that it would be helpful to return to a system where transplant centers had a specific liaison with the OPTN. Another member commented that perhaps individuals should be elected based on what platform they support. A member noted that the roles of regions have changed over the years and with a move to broader allocation, regions may not be necessary anymore. The concept of “Communities of Practice” or of Expertise were considered as one way in which the nation could be distributed regarding action items.

Region 3 | 09/10/2021

One attendee commented that with any of the models submitted, it appears the regions will no longer have regional representation on the Board. Another attended remarked they support a model where fair representation is maintained.

Region 2 | 09/10/2021

Members of the region expressed interest in the progress of the work as it will be helpful for the donation and transplant community. It was also noted that any future structure should maintain a way for dissimilar groups to meet. The regional meetings are a great way to learn about different perspectives within the community. For example, a smaller transplant program will have different perspectives and priorities than larger transplant programs, but it is beneficial for both groups to interact in order to learn from each other.

Robert Goodman | 09/09/2021

I support making some changes to the regional system that exists today; at the moment I favor a mixture involving Model 3 as the base template. I caution, in general, that we do not want to create new silos that might overshadow the common good that we are all trying to achieve by being more transparent, open to hearing about others experiences, sharing best practices, etc. Our strategic goals of increasing the number of transplants, providing equity in access, promoting efficiency in donation and transplant, promoting patient and donor safety, and improving wait list outcomes cannot be compromised in any way. Discussion is healthy, sharing of ideas is important, debating is often necessary and at the end of the day, we need to do what's right to meet the rigors of our agreed upon strategic goals and hear from all member groups in the transplant community equally.

James Gleason | 09/05/2021

Based on my 20+ years of experience working on various committees and serving two 3-years terms on the board as a patient representative living 27 years with a transplant heart in Region 2, I welcome the opportunity to support the OPTN Regional Review Project with this public comment. First, let me say with all that experience, I have found the current process to have worked very effectively, offering all constituencies opportunities to participate in open discussions and finally to express their final position with a vote that directly impacts the issue at hand. I feel the current board membership with its representation of each community of interest is effective and should be retained in whatever change may come out of this review process. As to the three models offered, I accept Brian’s suggestion in the supporting video (which I compliment as an excellent overview of this comment opportunity) of supporting a combination of the models 2 and 3 EY presented. The current regions should be reviewed to see if a better number or boundary better serves the overall purpose in light of the changes that have certainly taken place since 1986 when these were originally formed. I do not know if there should be fewer, more or the same in number, but support a full review to answer that question based on transplant center geography, patient population and OPO service. Whatever comes out of that review, I feel the current process of electing board members should be retained, maintaining the balance of constituent representation we see today. While a particular topic may seem broad in scope, I certainly have come to recognize regional differences in how that topic is seen and reviewed, especially as it concerns service provision in various parts of the country where the density of patient need and center service support is extremely varied. That has served us well both in the regional meeting discussions and the carrying forward the content of those discussions to the national board level. As a patient I found the regional meetings to be very educational, especially on complex topics as debated and discussed by experts in their fields ‘well above my pay grade’, very important to my layman’s understanding in forming an opinion that carried on into even further discussion at the board meeting, either confirming or sometimes changing, my final vote as a result of that discussion/debate and voting process. The OPTN committee structure today allows for member engagement in a meaningful way, not only for those directly involved in some topic, but also for indirectly affected parties to learn and express differing opinions often from a totally different viewpoint than the more directly engaged expert practitioners as is most obvious between patients, donor family members and medical staff. I very much appreciated the respect those practitioners always had for my views as a patient, often expressed in the phrase “They may have done one, but they never had one…” referring to my own heart transplant. The current process in my experience was very supportive of that open view discussion and fairness I felt in having a vote in the final say on the proposal before me on that board. I hope these remarks address the themes suggested of allocation equity, community engagement, and participation in policy development. My thoughts and experience over these 20+ years don’t provide direct answers to many of the considerations under discussion, but I hope they support the discussion myself and so many other thoughtful minds offer in these public comments and in the follow-on discussions that will be held at many levels leading to keeping the best of what has been learned and practiced over the decades of use and change, with yet improved new ideas coming out of this review process. Thank you for this opportunity to reflect and share my experience and thoughts on a complex process that saves so many lives, my own included! As a long-term transplant survivor and spouse to a 'donor mom', I offer a unique perspective of being both recipient and donor family with decades of direct UNOS/OPTN engagement for which I am so thankful.

Paul Morrissey | 09/03/2021

As a previous Regional Councilor and member of the Board of Directors, I would like to comment on the OPTN Regional Review Project. I’ll comment in generalizations only or specifics as to UNOS Region 1 (my Region). In UNOS Region 1 we have a long history of collaboration between 14 transplant centers and two DSA. The states share common geography, similar populations, similar politics, and similar goals. This familiarity enables cooperation and common purpose and usually we reach common ground in areas of organ allocation and policy. I support maintaining this entity as a representative body to UNOS Committees and Board functions. The heart, lung and liver broader sharing areas and the kidney 250 nM circles are defined to optimize patient outcomes and equity. While important, these goals are distinct from the cooperation needed to develop policy and I would not support using patient-centered geographic entities to supplant UNOS Regions and UNOS Region 1 specifically. This will not limit sharing of information – that can happen at the committee level, but it will limit confusion and controversy in generating areas for discussion prior to Committee work. UNOS Region 1 offers a broad base of programs and interests representing all organs, varied size programs, and academic settings. We have a strong history of involvement at all levels of OPTN/UNOS. I suggest keeping Region 1 intact as a designated representative area at the OPTN and avoiding expansion to the large metropolitan areas in our geographic south.

Tim Taber MD, FACP | 09/03/2021

First of all, I believe that it is important to retain some degree of geographical determination of regions. My experience with Region 10 was that it provided a forum to discuss regional issues - especially with organ allocation - off-line but in-person that would be lost with the loss of a regional meeting. Expanding the size of the regions makes attendance somewhat more difficult but would be preferable to losing regional meetings entirely. How these regions would look, I believe, is less important again than retaining geographical regions. One of the complaints of regional make-up I have heard in the past has been the discrepancy of (primarily) numbers of transplant centers included in each region. If one felt the need to change the current regional make-up, I would focus on trying to more equitably divide regions by numbers of participating centers. This would tend to increase the number of current regions and thus avoid the concern of travel to a larger region's meeting. If the number of regions increased significantly, board membership eligibility would have to be re-evaluated as, is the current practice, automatically putting each region's councillor on the board would tend to decrease the number of available board positions for specific interest groups (patients, OPO's, etc). I feel it is important that we keep the current number of board positions that are currently allocated to these interest groups.

OPTN Kidney Transplantation Committee | 09/02/2021

The Kidney Transplantation Committee appreciates the opportunity to comment on the OPTN Regional Review project. Committee members feel any new structure should still include consideration for inherent geographic differences and varied opinions between different regions/areas of the country, especially as OPO policies and practices vary. A committee member commented regions vary by size and population. Additionally, different regions vary in the types of transplant programs available, transplants offered, whether there are MOT programs, the volume of transplants performed, the patient population, and number of candidates on the waiting list. Members felt these were important points of consideration to be evaluated as part of the project. Additionally, a committee member commented in-person regional meetings are very beneficial as they offer a diversity in thought and multi-disciplinary opinions, and would want them to continue. Also, the member said clarity is needed on what a regional sentiment vote means and stressed the importance of having adequate regional representation at the Board level. A committee member expressed concern for potentially creating more silos within the transplant community if representation on committees and the Board are reduced and questioned how decreased representation would accomplish the goal of increased collaboration. Another committee member encouraged more engagement with patient organizations and patient groups to solicit the patient perspective to incorporate into the OPTN’s work. The member further expressed that patients are very capable of participating in the OPTN policy process but information on how they can participate is not broadly shared.

Region 5 | 08/30/2021

Region 5 supports the OPTN Regional Review Project and provided the following notable comments and suggestions. A member cautioned that some of the proposed changes could produce silos of common interest. Further, grouping by the number of centers doesn’t make sense; rather, the member suggested grouping by equal numbers of people and potential people. This member suggested there should be four to five regions rather than eleven regions. A member suggested that it would be nice to have an option that retains current boundaries just for measuring general sentiment. Further, Model 1 is the least desirable option since there are already ample communities of common interest. A member suggested increasing the number of center interactions for organ offer and placement to achieve optimal efficiency. A member requested more information on the size of regions, specifically, patient size. A member expressed concern over the appointment process and believes that can be addressed as part of the regional review project. Many members support a review of the regional structure. A member strongly supports an update of the regional organization structure but wants to see some continuity with the current structure. The member suggests to update regional structure to better balance patient populations, number of centers, and center/OPOs that routinely work together.

Region 4 | 08/27/2021

Many attendees had feedback for the committee and provided the following comments: There are many changes happening right now and changing the regions may not be needed. Changes would affect hospital agreements with OPOs, and relationships between hospitals and OPOs. OPTN committees already function to provide interest specific communities. If some are not represented, maybe we need more committees or subcommittees. I believe patients should be better represented at regional meetings, and would support the idea of creating regional patient committees, perhaps led by the regional PAC rep. Several attendees supported leaving the regional system as it currently exists. They commented that the system is working well and there should not be change just for the sake of change. Transplant Centers and OPOs share common issues and even though allocation is broader, the local support between center and OPOs should be maintained. The model of common interests makes little sense to me and re-drawing lines based on population has little effect now that allocation no longer even uses regional boundaries. If you want the OPTN members to have the belief that our voices are heard, we need to function more like a representative system where regional representatives cast a vote representing his/her region then OPTN adapt policy based on the votes of the regions. There remains value in geographic representation and collaboration. There are regional differences in patient populations, shared challenges of logistics and travel, etc. Simultaneously, the diversity of interests within a region brings diversity of perspective to discussions of common importance. A system based only common interest risks isolating groups with different interests in silos, fostering competition rather than collaboration. As many centers will have multiple programs with different interests, it also presents logistical challenges to participation and representation.

OPTN VCA Transplantation Committee | 08/20/2021

The VCA Transplantation Committee appreciates the opportunity to comment on the OPTN Regional Review project. A member noted that the OPTN Board of Directors (BOD) is quite large and expressed support for restructuring the BOD. Another member expressed concern that some of the ideas developed by EY, particularly organizing around communities of common interest, might actually result in more silos among OPTN members. The member felt that multidisciplinary forums enrich discussions around OPTN policy. However, since some people do not always feel empowered to voice their opinions in the current OPTN structure, there may be opportunities for improvement in this area.

Kidney Assist | 08/11/2021

I beg of you to initiate a program similar to the NKR where patient’s family members (that are incompatible blood matches) or friends can secure a voucher for a kidney transplant (or probably the way you’d administer it would be by placing them at the top priority to receive a transplant) by donating on their behalf to the next person which they match with on UNOS’s waiting list. Everyone would gain. The next person on the UNOS list would get a living kidney instead of a more inferior cadaver kidney and the living donor will help his beneficiary family member or friend be transplanted in a more prompt fashion (offsetting the lack of compatibility issue)