Committee Spotlight

Chimera Fall/Winter 2019 Issue

Standards and Quality Committee

Thirty representatives from ASTS, AST, AOPO, OPOs, UNOS, and the airline, emergency ground transportation, and insurance industries gathered July 25-26, 2019, for the ASTS Standards and Quality Committee Safety & Transportation Summit. They tackled long-standing issues involving safety and transportation of organ recovery teams by identifying barriers and building a plan to develop guidelines, standards, education programs, and resources for the community.

Chimera Summer 2019 Issue

The ASTS Spring Council and Committee Chairs Meeting was held May 31-June 1, 2019, at the Westin Hotel in Boston, Massachusetts. The following are select news and reports from the meeting, arranged according to the focus areas in the Strategic Plan. If you have questions or comments about any committee activities, please contact the committee chair.

Optimal Patient Care

  • Diversity Issues Committee: Dr. Jayme Locke discussed the committee’s recent focus on gender barriers and disparity in the workplace. Dr. Locke presented a few projects that the committee would like to work on and the estimated costs of each project. She asked the Council to consider prioritizing the projects to be included in the 2020 budget.
  • Standards and Quality Committee: Dr. Kandaswamy gave an update on the Transportation and Safety Summit in July 2019. He requested the Council approve additional funding in the amount of $2,500 to cover expanded participation if other funding is not found. He also reported that the committee is working on a joint white paper with AOPO on best practices for renal biopsies; advising the Society for the Advancement of Transplant Anesthesia and The Alliance on an educational tool for end of life care; advising on an RFP for the immuno bill; and providing recommendations on comments on UNOS proposals. Future ideas include certification of organ recovery professionals outside the center; technology for real-time video communications during recovery; and best practices for consent on the use of HCV+ organs.

Training and Professional Development

  • Fellowship Training Committee: Dr. Hirose reported on the 2018 Fellows Symposium and planning for the 2019 Fellows Symposium and the 2019 Program Directors meeting. He reported on the 2019 for 2020 Abdominal Transplant Surgery Fellowship Match and program accreditation moving to the TACC. A burnout and work/life balance survey of the fellows is planned. He reported on the new surgical log platform and presented the committee’s future initiatives: monitor compliance with non-operative milestones, renal hilum dissection model, the 2020 Education Workshop, and a possible Fellow Bootcamp.

Research

  • VCA Committee: Dr. Tzakis stated that the committee is organizing a consensus conference in November 2019 with speakers in the field of VCA, third party carriers, and patient groups, and is developing a module for the Academic Universe for CME credit.

Advocacy

  • Legislative and Regulatory Committee: Dr. Pomposelli presented an RVU project for organ recovery fees. He stated that the committee plans to work with the Standards and Quality Committee and external stakeholders to develop general principles and standardization. He asked for Council feedback on this project. It was suggested to circulate best practices and to consider organs that are used for research rather than transplanted. Dr. Mulligan volunteered to collaborate with the committee.

    On May 2, 2019, ASTS held another successful Advocacy Day. A 19-member delegation representing ASTS membership and staff, AAKP, and event sponsors from CareDx and Sanofi Genzyme met with Congressional staff and U.S. Representative Stephen Lynch (D-MA-08). ASTS promoted the Living Donor Protection Act of 2019 (LDPA) (H.R. 1224, S.511) and educated congressional staff on the unintended consequences of legislation resembling the Dialysis PATIENTS Demonstration Act of 2017 (DPDA).

Chimera Spring 2019 Issue

The ASTS Winter Council and Committee Chairs Meeting was held January 9-10, 2019, at the Loews Miami Beach Hotel. The following are select news and reports from the meeting, arranged according to the focus areas in the Strategic Plan. If you have questions or comments about any committee activities, please contact the committee chair.

Organizational Excellence

  • ASTS Foundation: Ms. Maggie Kebler-Bullock presented the new Board of Directors and reported on individual contributions, noting 100% participation from the ATP Committee. She also presented the sponsors of the Presidential Student Mentorship Grants and lifetime giving levels.
  • Bylaws Committee: Dr. Liise Kayler presented a suggested language change to eliminate the 6-month waiting period to transition from candidate to regular member. The Council approved the proposal, which will be voted on by the ASTS membership at the Town Hall in June.
  • Membership & Workforce Committee: Dr. Sunil Geevarghese presented the committee’s initiatives: proposed AST dual associate membership, improving the member portal, removing the 6-month waiting period for candidate members to transition to regular membership, and the workforce survey manuscript.
  • Ethics Committee: Dr. Sande Florman presented the committee’s review of position statements on ASTS.org and recommendations to archive 4 and revise 1 statement. Dr. Kaufman assigned the committee to revise the DCD statement.

Optimal Patient Care

  • Standards and Quality Committee: Dr. David Axelrod reported that the committee drafted responses to UNOS proposals and worked with the MACRA Task Force and ACS on alternate payment models. The Renal Biopsy Subcommittee has fielded a survey and is working on a paper to be completed by summer 2019. The Safety and Transportation Subcommittee is working to understand safety and insurance issues around procurement and organ travel. A follow up meeting with external stakeholders to address joint safety issues was approved.
  • Diversity Issues Committee: Dr. Jorge Ortiz presented updates on the A2>B paper, investigating a gender gap in authorship of journal articles, the paper on culturally competent websites, the workplace harassment survey, and monitoring changes in allocation policy for effects on access to transplant for disadvantaged populations.
  • Living Donation Committee: Dr. Michael Zimmerman presented the committee’s activities: looking at utilization of NLDAC, obesity in living donation, and global kidney exchange.
  • NSQIP Transplant Task Force: Dr. Ryutaro Hirose reported that the name of TransQIP has changed to NSQIP Transplant. The system is currently in its beta phase, with transition to production phase and expanding the centers involved in 2020.
  • Obesity Task Force: Dr Ty Diwan presented survey results on center practices regarding obesity and the outline of a white paper on obesity.

Research

  • VCA Committee: Dr. Andreas Tzakis reported that a module about VCA has been added to the ASTS Academic Universe. A VCA Consensus Conference was approved for 2019.
  • Grants Review Committee: Dr. David Foley presented the 2019 Recognition Awards and the 2019 Research Grants portfolio.
  • Scientific Studies Committee: Dr. Ty Dunn announced a new focus on pursuing novel information. The committee has been involved in looking at frailty in kidney and liver patients. She presented the liver steatosis study; a program proposal was accepted for ATC 2019.
  • Cellular Transplantation Committee: Dr. Jason Wertheim presented the committee’s initiatives, including a survey on center practices. He presented mid-analysis data from the survey.
  • Transplant Therapeutics Consortium: Dr. Mark Stegall gave an update on the initiative, now in the implementation phase. A white paper has been accepted by AJT, and the biomarker group is also writing a white paper

Training and Professional Development

  • Vanguard Committee: Dr. Daniela Ladner gave an overview of the 2019 Winter Symposium program and changes to this year’s meeting.
  • ATC Planning: Dr. Devin Eckhoff presented an update on the 2019 American Transplant Congress, including milestones, changes to the program, and State of the Art speakers.
  • ATP Committee: Ms. Haley Hoy presented the ATP Certificate of Educational Achievement update and improvements to the ATP section of the website.
  • Curriculum Committee: Dr. Marc Melcher reported the HBP module is nearly complete, and the committee has revised/replaced 9 modules, with 19 more in the works. A new learning management system was approved, and the video library is being updated.
  • CME Committee: Dr. Matthew Levine presented next steps for the committee, including the ABMS continuing education report open for public comment.
  • Business Practice Services Committee: Dr. David Mulligan announced that financial bootcamps will alternate years with the Leadership Development Program. In fall 2019, there will be back to back kidney and liver bootcamps.
  • Hands-On Education Task Force: Dr. Mark Hobeika and Dr. Ty Diwan gave an update on the combined DCD/LDN workshop planned for 2019.
  • Pipeline Task Force: Dr Dorry Segev presented proposed initiatives including a resident survey, a podcast, and an ASTS Pipeline Award.
  • Transplant Accreditation and Certification Council: Dr. Marwan Abouljoud presented the certification pathway and recent reaccreditation and accreditation activities. Beginning in 2019, accreditation activities will be under the TACC instead of FTC. He gave an update on TACC committee development. Dr. Wendy Grant gave an update on the Knowledge Assessment process.
  • Fellowship Training Committee: Dr. Ryutaro Hirose reviewed the 2018 Fellows Symposium and presented a renal hilum dissection simulation model and pilot study outline. He also presented information about the 2019 for 2020 Match.
  • Pediatrics Task Force: Dr. Carlos Esquivel presented the task force’s priorities for 2019: creating an ASTS certification for pediatric transplantation and creating clinical guidelines on topics related to pediatric solid organ transplantation for publication in peer reviewed journals.

Advocacy

  • Legislative and Regulatory Committee: Dr. James Pomposelli presented recent legislative initiatives, including the inaugural Advocacy Day in 2018. He encouraged everyone to consider participating in the next one. He presented recent regulatory activities, including drafting comments for UNOS proposals out for public comment and advising Powers on drafting comments to a CMS proposed rule. The committee’s priority is a second Advocacy Day in spring 2019. Ms. Diane Millman presented regulatory key objectives for the Society, including administrative simplification, which ASTS has pursued via comments and meetings. Another objective is to increase clinically appropriate transplantation, and there has been progress with CMS proposing to eliminate Medicare outcomes requirements for transplant center re-approval. A demonstration project has been presented to the Center for Medicare & Medicaid Innovation (CMMI) with a positive reception, and a referral metric has been added to dialysis center quality reporting. ASTS met with the Office of the Assistant Secretary for Health to urge focus on organ shortage as a public health issue. Ms. Peggy Tighe presented efforts to oppose the PATIENTS Act/DPDA and to support the Living Donor Protection Act, including Rep. Herrera-Beutler’s successful request to the Department of Labor to clarify that FMLA can be used for organ donation.
  • MACRA/QPP Task Force: ;Dr. David Reich gave an update on MACRA/QPP implementation.
  • American Medical Association liaison: Dr. Thomas Peters reported on the AMA interim meeting in 2018 and transplant-related issues that arose He noted that ASTS could write resolutions to address issues in the regulatory and legislative spaces. Dr. Kaufman noted the importance of ASTS members belonging to the AMA.
  • American College of Surgeons liaison: Dr. Lewis Teperman gave an update on the Board of Governors of the ACS meeting in 2018 and presented statistics on gender diversity and burnout. He also reported on ACS education efforts.
  • American Board of Surgery liaison: Dr. Abouljoud gave an update on the American Board of Surgery activities, including the evolution of continuous certification.

Chimera Fall 2018/Winter 2019 Issue

Advocacy

AMA Liaison: At the American Medical Association Interim Meeting on November 12, the House of Delegates voted to reaffirm AMA policy and Refer for Decision a resolution dealing with forced organ recovery practices. The body noted ethical guidelines for transplantation are set forth by the AMA, the World Medical Association, and the World Health Organization (WHO). ASTS testified before the reference committee and the House to promote ethical organ donation and transplantation practices.  

Organizational Excellence

Bylaws Committee: The Bylaws Committee reviewed a membership bylaws change proposed by the Membership & Workforce Committee and voted to submit it for Council approval in January. If the Council approves, it will be voted on by the membership at the Town Hall meeting in June.

Communications Committee: The Communications Committee developed a new feature for the Chimera, “Surgeon Spotlight,” featuring a junior and senior faculty member answering the same set of questions. The committee is also coordinating the UNOS Innovation Event at the 2019 Winter Symposium.

Ethics Committee: The Ethics Committee is reviewing ASTS position statements posted on ASTS.org and will make recommendations for which should be removed or amended at the January Council and Committee Chairs meeting.

Membership & Workforce Committee: The committee proposed a membership bylaws changes to the ASTS Bylaws Committee for review. The Bylaws Committee voted in favor of the proposal and will be presenting the change to Council at the January meeting at the Winter Symposium.

Training and Professional Development

ATP Committee: Since launching the ATP Certificate of Educational Achievement in June, 35 ATPs have enrolled in the program and 17 have enrolled in the exam. The ATP Committee has finalized their speakers for their ATP session program at Winter Symposium. The committee is working on creating a dual ASTS/AST membership category for ATPs.

Curriculum Committee: The Curriculum Committee recently completed reviewing all 115 modules in the National Transplant Surgery Curriculum. Recently a hepato-pancreato-biliary unit has been added to the National Transplant Surgery Curriculum with 11 new modules. The Curriculum Committee will now begin reviewing surgical videos with an aim to improve how the videos are featured and used in the Academic Universe.

Fellowship Training Committee: The Fellowship Training Committee (FTC), led by Dr. Ryutaro Hirose and Dr. Andre Dick, recently completed the 2019 Fellowship Training Program Accreditation and Reaccreditation application review cycle. The committee reviewed 32 reaccreditation applications and 1 accreditation application. This is the final year the FTC will be involved in this process as the duties will be transitioned to the Transplant Accreditation & Certification Council (TACC).

Optimal Patient Care

Diversity Issues Committee: The committee has fielded a survey on workplace stressors with a view to establishing preventative measures to ensure the continuation of a welcoming environment.

Living Donation Committee: The committee has been updated on the Global Kidney Exchange (GKE) and is working to determine how they can be involved.

Pediatrics Task Force: The Pediatrics Task Force submitted program proposals on pediatric transplantation for consideration for the 2019 Winter Symposium and ATC. Both proposals were accepted and added to the programs.

Research

Cellular Transplantation Committee: The committee is conducting a survey of ongoing research and clinical work in the areas of cellular products and therapies to summarize the current research and clinical work within our society as well as the broader research and clinical community.

Scientific Studies Committee: The committee has organized a multicenter study to 1) examine variability in pathology reading of steatosis in donor livers and 2) how steatosis affects outcome of liver transplantation. Also, the committee recommended the Executive Committee approve the AST Frailty report, which has been submitted to the AJT for review. The ASTS Executive Committee voted unanimously to endorse the report, entitled “Report from the American Society of Transplantation on Frailty in Solid Organ Transplantation.”

VCA Committee: The VCA Committee is working on organizing a VCA Consensus Conference that will bring together leaders in the field of VCA to speak on face, hand, and uterus procedures. The intent of this conference is to educate representatives from the medical insurance industry about VCA procedures with the aim of having insurance companies eventually cover the costs of VCA.

Chimera Summer 2018 Issue

The ASTS Spring Council and Committee Chairs Meeting was held June 1-2, 2018, at the Grand Hyatt Hotel in Seattle, Washington. The following are select news and reports from the meeting, arranged according to the focus areas in the Strategic Plan. If you have questions or comments about any committee activities, please contact the committee chair.

Organizational Excellence

  • ATC Planning Committee: Dr. Matthew Cooper and Ms. Shannon Fagan gave an update on the 2018 ATC, which saw a 33% increase from 2017 in program submissions and the highest abstract submission in 6 years.
  • ASTS Foundation: Ms. Maggie Kebler-Bullock presented an update on governance and bylaws changes. She also presented the new Board structure and an update on 2018 individual giving.
  • Bylaws Committee: Dr. Liise Kayler presented the committee members and activities, including a proposal to consolidate the international and regular membership categories.
  • Membership and Workforce Committee: Dr. Sunil Geevarghese presented new members in 2018 and renewal statistics. He reported that the workforce manuscript was submitted to AJT and thanked the co-authors who worked on it, especially Ms. Duan and Dr. Juan Rocca, who began the process.
  • Communications Committee: Dr. Satish Nadig presented the committee’s initiatives, including social media primers, the Chimera Perspectives column, and a refresh of the website’s design. A UNOS Innovation Event is being planned for the 2019 Winter Symposium. He said the committee is also interested in increasing communications between committees and other societies and spotlighting various wins in programs around the country in the Chimera.
  • Ethics Committee: Dr. Sander Florman commended committee members for addressing the issues sent to the committee, including making recommendations to the Council on a UNOS whitepaper on waitlist manipulation. The committee will review position statements and propose new ones if needed.
  • Historian: Dr. Tom Peters reported on the 2018 Chimera Chronicles honorees and the Richie-Johnson video, which should be posted this summer, bringing to 40 the number of interviews. He thanked Dr. Pruett for interviewing Dr. Sutherland in Minnesota.

Optimal Patient Care

  • Living Donation Committee: Dr. Amit Mathur presented proposed projects, including working with NLDAC to create a usage report for each program issued regularly, looking at enhanced recovery after surgery, and examining long-term impact of obesity in living kidney donors.
  • Diversity Issues Committee: Dr. Jayme Locke reported on work on the impact of KAS on minorities and on pediatric patients and collaborating with leadership on a submission for the NIH R25 grants. Cultural competency sessions have been held at ASTS meetings, and future ideas include examining disparities in access for vulnerable populations, collaborating with Leg/Reg Committee on access, continuing cultural competency programs, work with Membership and Workforce Committee on workplace discrimination or bullying, and addressing disparities in liver transplantation.
  • Standards and Quality Committee: Ms. Laurie Kulikosky presented recent initiatives, including the perfusion paper for AJT and working on the DCD workshop with the DCD task force. Two subcommittees have been formed: Transportation and Safety and Renal Biopsy.
  • TransQIP Task Force: Dr. Ryutaro Hirose acknowledged colleagues on staff at the American College of Surgeons for their help developing TransQIP. After 3 years of intense work, the group anticipates offering TransQIP to transplant centers across the country in 2019.
  • Obesity Task Force: Dr. Ty Diwan presented the group’s priorities, including a survey that will be sent to ASTS members once it is approved, a white paper, a large database study, and a national database.
  • Pediatrics Task Force: Dr. Carlos Esquivel presented data from the ASTS member survey, which was accepted as a poster for ATC 2018 and will be submitted for ATC 2019 as a program proposal.
  • PROACTOR Task Force: Dr. Mark Hobeika thanked the members and Council liaisons for their enthusiasm and work. He requested Council feedback on whether the Task Force should be dissolved or should remain to implement their report recommendations.

Research

  • Scientific Studies Committee: Dr. Ty Dunn presented the Frailty Consensus Conference report, at which committee member Dr. Nagai represented ASTS. She presented the liver steatosis study initiative the committee is working on and thanked David Lee, Sandy Florman, and Julie Heimbach for their help.
  • VCA Committee: Dr. Suzanne Ildstad presented the committee’s accomplishments and possible next steps, including modules for the Academic Universe and possible work on reimbursement.
  • Grants Review Committee: Dr. David Foley presented the 2018 Research Grant portfolio and review process, as well as the recipients of the 2018 grants. Dr. Emond announced that the Resident Scientist Scholarship has been renamed in honor of Dr. Jonathan Fryer.
  • Cellular Transplantation Committee: Dr. Jason Wertheim presented the survey on cell transplant practices, now in circulation.
  • Thoracic Committee: Ms. Ning Duan reported on the committee’s work developing recommendations for UNOS proposals. She also presented proposed initiatives for the committee.

Training and Professional Development

  • Vanguard Committee: Dr. Daniela Ladner reported on the 2018 Winter Symposium and gave an update on the 2019 Winter Symposium, to be held January 10-13, 2019, at the Loews Miami Beach Hotel. Abstract submissions are being accepted through September 10, 2018.
  • CME Committee: Dr. Matthew Levine reviewed CME and MOC offerings for the past year and presented future priorities, including the changing landscape of MOC and working with other educational committees. Dr. Abouljoud explained the ABS transition to Continuous Certification will be gradual and voluntary during the transition. There will also be a modular component of the ABS exam for which the CME Committee could provide materials.
  • Curriculum Committee: Dr. Marc Melcher reported the committee has reviewed 105 of 122 modules and is creating new learning objectives and board-style questions and working on a new HBP curriculum. Anyone interested in updating or creating a curriculum module should contact Jill-Morgan Aubert, ASTS Education Coordinator.
  • Advanced Transplant Provider Committee: Ms. Haley Hoy announced that 8 members have already completed the ATP Certificate of Educational Achievement. She presented the committee’s priorities: market the certificate program, finish compiling the compensation survey, and develop an ATP job description. A new webpage with resources for ATPs has been published on ASTS.org.
  • Transplant Accreditation and Certification Council: Dr. Marwan Abouljoud gave an overview of current fellowship training activities and the TACC strategy meeting in April. He presented the framework of the TACC governance structure and the program accreditation review process, which will now be done by the TACC rather than the Fellowship Training Committee. Dr. Wendy Grant presented the activities of the Knowledge Assessment Committee (KnAC) and the Knowledge Assessment Pathway, as well as the HPB Common Program Requirements.
  • Fellowship Training Committee: Dr. Ryutaro Hirose presented information on the 2018 for 2019 NRMP Match and the 2018 Program Directors Meeting. He gave an update on the 2018 Fellows Symposium and the 2018 LDN Workshop. He presented the Fellowship Bootcamp proposal, which will be presented to fellowship training program directors at the program directors meeting.
  • Business Practice Services Committee: Dr. Kenneth Andreoni presented an update on the Kidney Transplant Fellowship Bootcamp (August 10), 2018 Leadership Development Program (September 23-26), the BPS/Advocacy seminar at the 2019 Winter Symposium, and a proposed liver bootcamp in 2019.
  • DCD Task Force: Dr. Mark Hobeika gave an update on the DCD Workshop and presented attendee feedback. The group hopes to hold more workshops and expand the course. He also presented the group’s work with the Standards and Quality Committee and AOPO on the DCD liver practice survey.
  • Pipeline Task Force: Dr. Dorry Segev presented the members and potential projects for the upcoming year focused on residents, medical students, mentorships, and the job market. The goal is to present options to the Council by the January meeting. He asked for feedback and suggestions.
  • Wellness Task Force: Dr. Abouljoud reported the group plans to develop resources on wellness for the website, develop a standing session at the winter symposium, and create organizational frameworks for wellness and safety. They hope to develop a statement on fellow and surgeon wellness for the Society.

Advocacy

  • Legislative and Regulatory Committee: Ms. Peggy Tighe presented the recent initiatives in opposition to the PATIENTS Act and reported that Jaime Herrera-Beutler sent a letter to the Department of Labor directing them to clarify that FMLA can be used for organ donation. Ms. Diane Millman gave an update on comments to Medicare Advantage capitation rates and the regulatory relief effort. ASTS has met with HRSA and CMS to request a review of duplicative regulations. Ms. Jennifer Nelson-Dowdy presented the proposal for a fall fly-in open to ASTS members.
  • MACRA Task Force: Dr. David Reich gave a brief MACRA update and asked for feedback on the ACS/Harvard/Brandeis project. He also presented priorities for the Task Force and future considerations.
  • UNOS Liaison: Dr. Mitchell Henry reported that ASTS partnered with UNOS to spread the word about the SIR survey. ASTS submitted comments on the proposals out for public comment.
  • AMA Liaison: Dr. Tom Peters reported that ASTS has introduced 2 resolutions for the AMA House of Delegates Annual Meeting, supporting the Living Donor Protection Act support and opposing the PATIENTS Act. The American College of Surgeons cosponsored the resolution opposing the PATIENTS Act. He presented the ASTS priorities regarding the AMA and future ideas and encouraged everyone to join the AMA.