Update on OPTN Regional Review Project

At a glance

Current policy

The Organ Procurement and Transplantation Network (OPTN) Regions were created from groupings of Donation Service Areas (DSAs) to help manage the national organ transplant network. These regional boundaries were based on patient referral and organ sharing patterns when they were created in 1986. Each region has a representative serving on the OPTN Board of Directors and on most committees to ensure thorough consideration of how transplant policy may affect people and institutions in the United States.

The OPTN is seeking feedback on how regions, or a different model, can best fulfill the functions below for OPTN members and stakeholders. The main functions of the OPTN Regions are:

• Representation: to elect regional representatives to the OPTN Board of Directors and OPTN Committees
• Communication and feedback: to gather sentiment on policy proposals
• Operations: to include discussions about shared operations and effective practice
• Data analysis: to describe geographic differences in transplant data at the Regional level

The OPTN and the broader transplant community have significantly evolved over the past 25 years. The purpose of the OPTN Regional Review project is to optimize OPTN governance and operational effectiveness by evaluating the role of regions. This request for feedback aims to gather input from the transplant community to determine whether changes to the OPTN structure should be pursued via a future policy proposal.

Supporting media

Presentation

View presentation

Requested feedback

An independent consulting group performed a review and analysis of the OPTN regional structures and processes. This request for feedback includes their early findings and three proposed models for a new OPTN structure. These models should be viewed as a list of ideas, rather than a limited set of recommendations.

• Model 1: Communities of Common Interest
  • Regions would be replaced with alike communities, such as non-academic transplant centers or rural organ procurement organizations (OPOs)
  • Policy debate at these community meetings would be focused on policies of greatest interest to their group
  • Communities would elect Councilors, who would hold seats on the Board

• Model 2: Repurposed Regions
  • Regional boundaries would be redrawn based on population or OPTN membership count
  • Policy debate would occur at a national meeting
  • Regions would elect regional leaders to form a Regional Advisory Body to the Board

• Model 3: Hybrid Cohorts
  • Regions would continue to be based on geography for transplant centers, OPOs, and histocompatibility labs
  • Patients and donor families would be grouped into national cohorts
  • Boundaries of regions would be redrawn to better reflect new organ allocation rules and practices

Considerations

• What is the optimal governance structure to best perform OPTN functions?
• How should the OPTN organize members into smaller forums?
• How should the OPTN ensure members have a voice in policy?
• How can Regions, or an alternate construct, serve members and enable OPTN’s strategic goals?
• What role should geography play in the OPTN structure and functions?

Anticipated impact

• What it's expected to do
  • Your feedback will aid the OPTN Board of Directors in deciding whether to propose changes to the OPTN structure, and if so, what a new OPTN structure should look like
• What it won't do
  • This paper is not a proposed policy change, but will help inform future policy development

Themes

• Allocation equity
• Community engagement
• Policy participation

Terms to know

• Donation Service Area (DSA): The geographic area designated by CMS that is served by one organ procurement organization (OPO), one or more transplant centers, and one or more donor hospitals. 
• Organ Procurement Organization (OPO): Non-profit organization responsible for the procurement of organs for transplantation.
• Policy Oversight Committee (POC): The Committee advises the Board of Directors and Executive committee in developing strategic policy priorities, prioritizing and coordinating policy and committee projects, and evaluating policy and committee proposals prior to public comment.
• Regions: For the administration of organ allocation and appropriate geographic representation within the OPTN policy structure, the membership is divided into 11 geographic regions.

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