Pediatric transplantation is a subspecialty within the field of transplantation. In the current OPTN Bylaws, the primary surgeon and primary physician are not required to have pediatric training or experience in order to serve as key personnel at programs that perform pediatric transplants. The Bylaws’ silence on pediatric program requirements means that there is not a universal standard of quality in pediatric care, which, in the most rare and serious of circumstances, could pose a risk to patient safety. In 2012, the Board of Directors included developing separate program requirements for pediatric programs as a key initiative under Goal 4: Promote Patient Safety of the OPTN/UNOS Strategic Plan and charged the Pediatric Transplantation Committee with developing Bylaws that fulfill this key initiative. The Committee proposes that a designated transplant program must have an approved pediatric component in order to perform transplants in patients less than 18 years old. To be approved for a pediatric component, a program must identify a qualified primary pediatric surgeon and a qualified primary pediatric physician to serve as key personnel.