UNOS Update Region 9 Yolanda Becker MD OPTNUNOS

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

Source: www. irrationallabs. org Relativity ∆ above worst txd kidney (rather than KDPI comparison among txd kidneys) Expected survival with vs without tx 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 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 Report on Organ Offers • 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.

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