Revise pediatric emergency membership exception pathway
Sponsoring Committee: Pediatric Transplantation
Strategic Goal: Improve waitlisted patient, living donor, and transplant recipient outcomes
Policy notice (PDF 293K; 12/2017)
Pediatric Committee Board briefing paper (PDF - 468 K; 12/2017)
In December 2015, the OPTN/UNOS Board of Directors (Board) approved minimum training and experience requirements for key personnel at pediatric heart, kidney, and liver transplant programs. An emergency membership exception pathway (pathway) was included in the proposal for adult heart and liver transplant programs that did not meet the pediatric key personnel requirements, but wanted to register a patient less than 18 years old on the waiting list. The intent of this pathway was to allow a one-time membership exception for the identified patient under certain exigent circumstances. Members of the Board recognized opportunities for improvement and requested the OPTN/UNOS Pediatric Transplantation Committee (Committee) work on amendments to the pathway.
The Committee collaborated with the OPTN/UNOS Membership and Professional Standards Committee (MPSC) to amend the pathway in 2016. The proposed changes include objective requirements for heart and liver transplant programs that want to register a candidate less than 18 years old. These changes will address concerns over:
- the OPTN’s ability to monitor and enforce the requirements,
- subjective and ill-defined language in the prior version of the pathway,
- how the pathways will work operationally, and
- what objective criteria will be used to determine when it is acceptable to transplant a pediatric candidate using one of the pathways.
The scope of this proposal only includes modifications to the emergency membership exception pathways for heart and liver transplant programs. Modifications to the minimum training and experience requirements approved by the Board in 2015 are not being made.
Read the full proposal (PDF - 293 K)
The Committee requests feedback on the entire proposal. Additionally, the Committee is seeking specific feedback on the following:
When this proposal was first developed, members of the Committee felt that critical care transport services for patients on extracorporeal membrane oxygenator (ECMO) were not widely available. Thus, ECMO was included in the pathway for heart transplant programs. Since that time, some members feel that transport services for patients on ECMO are more widely available. Should the emergency membership exception pathway for heart transplant programs include the option for a patient on ECMO?
- Small: UNOS IT effort to reflect new time and offer limits is estimated at 360 hours
- IT Implementation work to be completed with Pediatrics Bylaws (approved December 2015)
- Member Quality effort may increase during implementation due to complex monitoring
- Immediate to 1 month implementation time upon programming for members
- Minimal staff effort to adjust to new pathway and to provide training.
- No ongoing cost
IT implementation effort is small to create and test waitlist changes. While IT hours are estimated at 360 for implementation, an additional 360 hours are planned, time permitting, for architecture work to provide functionality for the Organ Center and other enhancements. This proposal would be implemented with the Pediatrics Bylaws Proposal (approved December 2015), so implementation time needed will extend beyond twelve months.
Member Quality effort may increase during implementation. Approval of these revisions, however, produces savings in projected Member Quality resources since the approved Pediatrics Bylaws (December 2015) due to reduced scope of work. This includes changes to an internal database, and a mechanism to review materials from adult heart and liver transplant programs that choose to use these pathways. It is anticipated the request will be infrequently used, however, so ongoing hours should not increase.
Hospital: Administrative staff time to review and educate team members on new pathway is a minimal cost. Staff must understand listing changes, create patient updates and change forms. There are no cost savings or ongoing costs. Variables such as current number of staff or change in transplant volume can impact cost, but this change should be absorbed into standard operating costs.
Lab and OPO: Minimal or no impact.