Sponsoring Committee: Vascularized Composite Allograft (VCA) Transplantation
Strategic Goal: Promote living donor and transplant recipient safety
Policy notice 1 (PDF - 50 K; 7/2018)
Policy notice 2 (PDF - 92 K; 7/2018)
Effective pending programming and notice to members
Board briefing paper (PDF - 519 K; 6/2018)
Read the full proposal (PDF - 874 K; 1/2018)
In December 2015, the OPTN/UNOS Board of Directors approved changes to the Bylaws to remove the ambiguous term “foreign equivalent” from the transplant program key personnel requirements. Members and the Membership and Professional Standards Committee found it difficult to determine if a board certification or case experience performed outside the United States should be considered equivalent. In lieu of accepting foreign board certification, the Board approved continuing education pathways in order for individuals who were foreign board certified or U.S. board ineligible to continue to be considered for key personnel positions at solid organ transplant programs. These changes were not made to the membership requirements for key personnel at vascularized composite allograft (VCA) transplant programs due to feedback from professional transplant societies concerned about the impact of such changes on the nascent developmental stage of the VCA transplant field.
The current membership requirements for VCA transplant programs in the OPTN Bylaws include a pathway for non-board certified individuals to qualify as a primary VCA transplant surgeon. However, this pathway will sunset on September 1, 2018. The VCA Committee feels the implications of this sunset would:
- be overly restrictive
- result in membership requirements that were dissimilar to the membership requirements for all other solid organ transplant programs
- prohibit a surgeon who is U.S. board ineligible, but otherwise well qualified by training and experience, to qualify as a primary VCA transplant surgeon
This proposal addresses this gap for surgeons who wish to apply to be a primary VCA transplant surgeon. This proposal is not intended to reduce the rigor of the training and experience requirements for key personal at VCA transplant programs. Rather, it is intended to add an option for these surgeons that is consistent with the of membership requirements for all other solid organ transplant programs.
The Committee feels this proposal is in keeping with Goal 4 of the OPTN Strategic Plan by ensuring consistency between the requirements between key personnel at solid organ and VCA transplant programs. It will also address a problem posed by the increased burden for individuals to qualify as a primary VCA transplant surgeon if the sunset provision is not amended.
The Committee encourages all interested individuals to comment on the proposal in its entirety. The Committee requests feedback on the following three items:
- When considering the addition of a continuing medical education (CME) pathway, the Committee felt select elements of the pathways were broad and this may lead to lack of clarity for OPTN members. Should “category-one” CME and “self-assessments” be more specifically defined?
- The Committee discussed whether “foreign board certification” should remain in Appendix J to ensure some level of advanced certification, should a surgeon be U.S. board ineligible. This concept would be to require foreign board certification in addition to a prescribed CME pathway for U.S. board ineligible persons. Do you feel this is an appropriate approach, or would this inclusion have unintended impact (e.g.: potentially exclude well qualified surgeons from being considered)?
- Should the language for the primary VCA transplant surgeon include a similar allowance as it does the primary VCA transplant physician such that a primary transplant surgeon or physician of any solid organ transplant program could qualify to be the primary transplant surgeon of a VCA transplant program? Would such an allowance diminish the rigor of the membership requirements for the primary transplant surgeon of head and neck, or upper limb transplant program?