UNOS Update Region 9 Yolanda Becker MD OPTN UNOS

UNOS Update Region 9 Yolanda Becker, MD OPTN/UNOS Vice President March 22, 2017 1

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COIIN 3

COIIN initial cohort Region Transplant Center 1 Brigham and Women’s Hospital 6 University of Washington Medical Center 2 Thomas Jefferson University Hospital 7 University of Chicago Medical Center 3 Augusta University Medical Center 7 Northwestern Memorial Hospital 3 Ochsner Foundation Hospital 7 Rush University Medical Center 4 Methodist Dallas Medical Center 7 University of Minnesota Medical Center 5 Scripps Green Hospital 8 5 University of Utah Medical Center University of Colorado Hospital/Health Science Center New York Presbyterian Hospital/Weill Cornell Medical Center 5 Mayo Clinic Hospital (Phoenix) 9 6 Virginia Mason Medical Center 10 Ohio State University Medical Center 6 Oregon Health and Science University Hospital 11 University of Virginia Health Sciences Center 14 OPO partners 4

COIIN year 2 timeline 5

Expediting the offer process: utility v. choice 6

To what extent is the community willing to limit our range of choices on individual organ offers in order to prevent discards and increase the number of transplants? 7

Liver Distribution Update

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 8 7 5 4 6 3 2 1 9

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. 10

Liver Distribution Options The Liver/Intestine Committee has asked the SRTR to model the following options: § Concentric Circles § § § 8 Districts § § § Optimized redistricting Share M/P 29+, 3 M/P Proximity points in 150 mi circle or DSA 8 7 5 32 4 1 6 Neighborhoods § § § 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 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 11

Liver Committee Work Plan 12

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 13

Call for nominations: 2018 -2019 Board of Directors 14

Goals for 2018 -2019 Board Improve diversity for a better overall balance in: § skill sets and professions § minority and gender representation § patient/donor backgrounds 15

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 16

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 17

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

Relativity Mental accounting Compare # of acceptances vs # waiting (instead of “up 5% over last year”) Default effect Most offers are declined, so screen better so that ‘yes’ is the more common decision Pre-enter ‘yes’ and allow centers to override with ‘no’ Choice overload Reduce amount of info to a half-dozen data points Build prediction model based on those points (connect back to pre-entering yes if predicted) Decision fatigue – whether acceptance rates go down with higher volumes of offers Identifiable victim Include photograph of recipient in offer Answer ‘accept’ or ‘discard’ instead of yes or no Decoy effect Create 3 rd dummy option, e. g. “accept unconditionally”, “accept and review”, “decline” Social proof Stop providing info about sequence number, location of donor This kidney has an X% chance of being transplanted Loss aversion This candidate will likely wait X days until the next offer This organ is x% likely to be txd by another center in this region Choice to “Keep this organ or release it to another tx center” Status and self-image Source: www. irrationallabs. org ∆ above worst txd kidney (rather than KDPI comparison among txd kidneys) Expected survival with vs without tx Recognition for most txs Recognition for highest acceptance rates Recognition for most ‘marginal’ organs used (national, regional, local)

UNOS Labs Mock Offer Simulation System § Web-based application designed for experimentation § Goal is to have similar look, feel, and content as current Donor. Net § 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

Data Portal Visualizations and Reports • • Members are able to access automated reports updated at least monthly. • Report on Organ Offers Launched a new, secure data portal within UNet in December 2015. 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.

NEW UNOS Benchmark Report 22

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 23

2016 Financial Results § Total FY 2016 OPTN expenses totaled $45, 995, 581 § Registration § Federal fees provided 88. 5% of funding. appropriations 11. 5% of funding 2016 Actual 54, 109 2016 Budget 56, 066 2015 Actual 53, 417 1, 957 registrations ($1. 6 million) below budget

2016 OPTN Expenses

FY 2017 finances § Registration Fee increased from $957 to $979 26

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.

UNOS Update Region 9 Yolanda Becker, MD OPTN/UNOS Vice President March 22, 2017 28