Published for Members of the American Society of Transplant Surgeons

Vol. XIV, No. 3 Spring 2009

President’s Letter 4 Member News 6 Legislative Report 8 Regulatory & Reimbursement 10 OPTN/UNOS Corner 12 LYFT 13 NLDAC 15 State of the Art Winter Symposium 16 American Transplant Congress 2009 22 Video Library 25 Job Board 27 Corporate Support 28 Foundation 29 Calendar 30 New Members 31

www.asts.org ASTS Council May 2008–May 2009

Pr e s i d e n t Tr e a s u r e r 675 North St. Clair Street John P. Roberts, MD (2009) Michael M. Abecassis, MD, MBA (2009) Galter Pavilion Suite 17-200 University of California San Francisco Northwestern University Chicago, IL 60611 Division of Transplantation Division of Transplantation Phone: 312 695.0257 505 Parnassus Avenue 675 North St. Clair Street, #17-200 Fax: 312 695.9194 Box 0780, Room M896 Chicago, IL 60611 Email: [email protected] San Francisco, CA 94143-0780 Phone: 312 695.0359 Phone: 415 353.1888 Fax: 312 695.9194 Timothy L. Pruett, MD (2010) Fax: 415 353.8709 Email: [email protected] University of Virginia Email: [email protected] Dept. of Surgery Co u n c i l o r s -a t -La r g e PO Box 800709 Pr e s i d e n t -El e c t Mitchell L. Henry, MD (2009) Charlottesville, VA 22908-0709 Robert M. Merion, MD (2009) The Ohio State University Phone: 434 924.9462 University of Michigan Department of Transplantation Fax: 434 924.5539 315 West Huron, Suite 240 1654 Upham Drive, #345 Means Hall Email: [email protected] Ann Arbor, MI 48103-4262 Columbus, OH 43210-1250 Phone: 734 936.7336 Phone: 614 293.4627 James D. Eason, MD (2011) Fax: 734 998.6620 Fax: 614 293.4541 Methodist University Hospital Email: [email protected] Email: [email protected] University of Tennessee - Dept. of Surgery Transplant Inst., 1265 Union Ave., Im m e d i a t e Pa s t Pr e s i d e n t Robert L. Kormos, MD (2009) 10 Service, S1011 Goran B. Klintmalm, MD, PhD (2009) University of Pittsburgh Medical Center Memphis, TN 38104-3499 Baylor Regional Transplant Institute Department of Surgery C700 Phone: 901 516.7070 3500 Gaston Avenue 200 Lothrop Street Fax: 901 516.2036 Dallas, TX 75246 Pittsburgh, PA 15213 Email: [email protected] Phone: 214 820.2050 Phone: 412 648.8107 Fax: 214 820.4527 Fax: 412 648.1029 Charles M. Miller, MD (2011) Email: [email protected] Email: [email protected] Cleveland Clinic Foundation 9500 Euclid Ave., Mail Code A-110 Pa s t Pr e s i d e n t Alan N. Langnas, DO (2009) Cleveland, OH 44195 Arthur J. Matas, MD (2009) University of Nebraska Medical Center Phone: 216 445.2381 University of Minnesota PO Box 983280 Fax: 216 444.9375 Department of Surgery, Box 328 UMHC 600 South 42nd Street Email: [email protected] 420 Delaware Street, SE Omaha, NE 68198-3280 Minneapolis, MN 55455 Phone: 402 559.8390 Peter G. Stock, MD, PhD (2011) Phone: 612 625.6460 Fax: 402 559.6132 University of California San Francisco Fax: 612 624.7168 Email: [email protected] Dept. of Surgery, Rm M-884 Email: [email protected] 505 Parnassus Ave. Richard B. Freeman, Jr., MD (2010) San Francisco, CA 94143-0780 Se c r e t a r y Tufts University School of Med Phone: 415 353.1551 Kim M. Olthoff, MD (2011) New England Medical Center Fax: 415 353.8974 University of Pennsylvania Hospital Department of Surgery Email: [email protected] Department of Surgery 750 Washington St Box 40 3400 Spruce Street, 2 Dulles Boston, MA 02111 Na t i o n a l Of f i c e Philadelphia, PA 19104 Phone: 617 636.5592 Katrina Crist, MBA Phone: 215 662.6136 Fax: 617 636.8228 Executive Director Fax: 215 662.2244 Email: [email protected] 2461 South Clark Street, Suite 640 Email: [email protected] Arlington, VA 22202 Dixon B. Kaufman, MD, PhD (2010) Phone: 703 414.7870 Northwestern University Med School Fax: 703 414.7874 Department of Surgery-Division of Email: [email protected] Transplantation

2 Chimera Spring 2009 www.asts.org Editor’s Letter

ow many times have you man- Keep reading Chimera for breaking in- tor with limitless imagination would only aged a clinical situation that formation on the other new opportuni- have been thrilled by the collaborations of Hyou’ve never personally seen ties in development. ASTS members in seeking to better the before? Isn’t the need to make important lives of increasing numbers of patients. judgments in the absence of definitive The proposal to base kidney allocation One must wonder what else he might have data, or huge clinical experiences the on LYFT (life years following transplan- accomplished if he had been able to use very essence of transplant surgery? Aren’t tation) has been hot and controversial. any or all of these Communications Meth- these moments what make your career ASTS members have played major roles ods now available at our fingertips. Let us intellectually challenging and thrilling? in the discussion. Dr. Richard Freeman honor him by embracing these new direc- While you will ultimately decide how to summarizes the most recent events in tions in Transplantation, and by choosing proceed and what to advise your patient, the very public debate. The updates on to be active participants in ASTS. communication with other transplant ASTS involvement in past and current experts can be exceptionally helpful. Legislative Activities, and in Regulatory Best Regards, ASTS and the Communications Com- and Reimbursement issues should also be Amy L. Friedman, MD mittee have been hard at work creating included in your required reading. Communications Committee Liaison mechanisms to facilitate these important SUNY Upstate Medical University interactions. Some communications are best in per- son. Apparently, many ASTS members James F. Whiting, MD Centerspan has been an important fo- agreed, as attendance at this year’s ASTS Chair, Communications Committee rum for expert level, international, 24/7 Winter Symposium in Marco Island was Maine Medical Center internet discussions of a wide variety of record-breaking. During the meeting the transplant related issues since 2002. Cen- second Chimera Chronicles, focusing Chantay Parks Moye terspan will soon be moving to the ASTS on Great Stories in Transplantation was Managing Editor website. For those who have already par- filmed and will soon be available. [email protected] ticipated in some of these exchanges, and those who have lurked without exposing It would be an oversight not to mention Karol A. Keane their presence (including government the recent accomplishment of the first Designs & Communications, Inc. officials and third party payer executives), U.S. face transplant by the Cleveland [email protected] the rapid opinions posted offer multiple Clinic team led by Dr. Maria Siemionow. perspectives, links to published data Lay press and media communication and, often, voluntarily provided avail- about this event was so effective that About the Cover ability of a discussant possessing relevant multiple, simultaneous observers imme- The cover photo is of a transplanted knowledge for off-line consultation. Im- diately proposed sending a Connecticut pancreas allograft, which was part of a portantly, this communication also offers woman whose face sustained extensive simultaneous living donor kidney and a type of virtual yet precious camaraderie injury from a chimpanzee’s attack a few deceased donor pancreas transplanta- spanning specialties, nationalities, and weeks later, directly to the face transplant tion which Dr. Jacqueline A. Lappin politics. team’s home base! has pioneered at Memorial Hermann Hospital-Texas Medical Center. Lap- The Communications Committee also This type of rapid patient referral for such pin heads the Pancreas Transplant has other initiatives, such as the Online an experimental transplant, based on Program and performed the surgery Clinical Forums. To reach these case dis- knowledgeable consideration of available with Dr. Jose Benito A. Abraham, cussions, go to the ASTS website (http:// alternatives, even prior to publication in Clinical Fellow at the Organ Trans- www.asts.org), through the Members’ the medical literature would have seemed plantation Program of the University Portal (log in with your user name and unimaginable to Dr. Willem Kolff. This of Texas Health Science Center. password), under Tools (left side of the Lasker prize winning surgeon credited with ASTS is grateful to Dr. Abraham for page), and click on Message Board. Each development of both the artificial kidney sharing his photo. of the seven categories (Cellular Trans- and the artificial heart, has just died at the plantation, Heart, Kidney, Liver, Lung, age of 97 years. He did not conceive of the If you have a photo that you would Pancreas and Small Bowel) hosts forums enormous number of patients his innova- like displayed on the cover of the on Research Projects and General Dis- tions would benefit or of the range of trans- Chimera, please e-mail it along with cussion topics. Why not be the first to plant procedures that would evolve in great a brief description to Chantay Parks start a forum? part, because of the supportive therapies he Moye. developed. This brave and focused inven- www.asts.org Chimera Spring 2009 3 President’s Letter

his is the last of my missives for tive counsel and lobbyist on the Hill, the Chimera as the ASTS presi- was invited to take part in the recent Tdent. From this point forward, health care summit at the White House there are less than 2 months remaining and is in a good position to alert us to in my term. Fortunately or unfortu- changes in policy that impact our pa- nately, there is no lame duck time in tients. Chair, Dr. Richard Freeman, and this presidency. other Legislative Committee members have been active in Washington. They The Obama administration is going to participated in their first “Fly-In” of the create opportunities and challenges for year April 1st. the world of transplantation. One of the opportunities will present itself within What we all need to do is to make our the monies that have been allocated to voices heard in the discussions. For the NIH for scientific inquiry. The chal- example, there are going to be regional lenges are going to be evident in the forums in a number of states to have forthcoming changes in the delivery of broader discussions about health- health care. care (http://thecaucus.blogs.nytimes. com/2009/03/06/white-house-plans- As an opportunity, the increased fund- regional-health-care-forums/). Our mem- John P. Roberts, MD ing may provide for better chances for bers should participate in these types ASTS President grant funding. I would hope that mem- of forums in order to gain knowledge bers who have had trouble with grant The Society needs to prepare itself for about the direction of the changes and funding in the recent past would renew the inevitable changes in health care to assure that our concerns are heard. their efforts to obtain funding. There that are appearing on the horizon with We should be willing to work with our are also a series of Challenge grants that the new administration. I, for one, be- elected representatives in Washington could have applicability to transplanta- lieve that there is the political will to during what is going to be a drawn out tion (http://grants.nih.gov/grants/guide/ make these changes. This will is going legislative and regulatory process. ASTS rfa-files/RFA-OD-09-003.html#SectionI). to be strengthened by the massive debt has done a lot of work in the past in The timeframe for submitting these that the country is accumulating and these areas and we should be well posi- challenge grants is quite short with the increasing burden of Medicare on tioned for the future. an application due date of April 27th. the financially strapped country. I don’t There may be additional funds available think that the Society alone can have Another important set of issues for the for Comparative Effectiveness Research much effect on changing the overall Society involve the policy developments (CER). Projects receiving these funds course of this policy development; but, by the OPTN. Currently there are 8 will need to meet this definition of in combination with other, larger orga- policy proposals available for public CER: “ ‘a rigorous evaluation of the im- nizations, we may be able to keep the comment on the OPTN website (http:// pact of different options that are avail- ship off the rocks. www.optn.org/policiesAndBylaws/public- able for treating a given medical con- Comment/proposals.asp). It is important dition for a particular set of patients.’ What the Society needs to focus on is that our membership be aware of these Such a study may compare similar treat- assuring that the issues specific to trans- proposals and submits comments. ASTS ments, such as competing drugs, or it plantation are heard so that we are not will be developing comments and we are may analyze very different approaches, drowned in a deluge of rapid changes interested in your thoughts. such as surgery and drug therapy.” made to the system. The issues regarding There are many aspects for transplanta- transplantation are frequently unique Two of the policy proposals deal with tion that could be examined using this and our patients, who are gravely ill, but wider sharing of livers for transplanta- mechanism such as a comparison of re- with hope, need to be protected from tion. These proposals include sharing of section versus transplantation for small the currents. To this end, we have had Status 1 livers regionally and allocation hepatocellular carcinoma. a presence in both the legislative and of livers regionally by MELD/PELD. regulatory processes on Capitol Hill. We expect these proposals to be con- Peter Thomas, who is our ASTS legisla- troversial.

4 Chimera Spring 2009 www.asts.org ASTS has been involved with the 35 years of age in recipients younger ting involved have applied for positions development of the kidney allocation than 35, similar to the current policy on the committees. ASTS also accepted policy. ASTS representatives formu- for patients younger than 18. This is nominations for president-elect, trea- lated a response to the RFI promulgated a relatively straightforward method surer and three councilors. by UNOS (http://www.asts.org/Tools/ to achieve the goal noted above. The Download.aspx?fid=889), and the rep- Kidney committee has returned to the In just over a month, my term will be resentatives attended the public forum drawing board to re-tool the proposal, over. It has been a very interesting and in St Louis. The concerns with the most likely without the inclusion of rewarding year. As I said in my first let- proposal primarily centered on the use LYFT. ter: “Over the last several years, I have of the metric termed “Life Years From had the opportunity to observe the Transplant” (LYFT). This metric was to One area of tremendous success has issues that the ASTS president has to allow calculation of the benefit of trans- been the joint venture of ASTS and face. The whole process is like tending a plantation from both the decreased AST in the development of the Ameri- garden where the gardener changes each pre-transplant mortality associated with can Journal of Transplantation. The year. There are new urgent issues that transplant and the life years gained af- growth of the journal has been spec- need immediate attention but usually ter transplantation. Some of the issues tacular. The impact factor of the Journal can be solved quickly much like weed- with LYFT were that it did not do a is now the highest among the transplant ing. There are other issues that are new good job with predicting outcome (rela- journals and is second only to the An- and require time to solve and, much tively poor concordance) and the long nals of Surgery in impact factor among like planting a tree, most of these issues time horizons chosen for the metric. surgical journals. We are all indebted to take several years to mature to fruition. Overall, the policy was far too com- Dr. Philip Halloran (Phil) who has been Some issues require protecting the gar- plex. The ASTS has suggested that the the editor since the inception of the den from disease.” We have sowed a lot UNOS Kidney Committee step back journal. Phil has been amazing in his of seeds during this past year, and there and reassess the goals of allocation. One dedication to the journal and the revo- has not been a lot of weeding or pest goal that has relatively good acceptance lutionary success of the Journal is testa- control necessary. I think the garden is is not to use kidneys from young donors ment to his hard work. Unfortunately, improving but there are huge challenges in patients who are very old. This situa- Phil is retiring as editor of the journal. ahead for us. tion has become more frequent because Over the next year the societies will be of the dramatic aging of patients on searching for a new editor. Ideally, this the waiting list. Because of the greater would be someone who could bridge number of older patients, younger pa- both the basic science and clinical areas tients cannot compete well as there as Phil did so well. We hope that there is little direction in the allocation of will be strong interest in the editorship kidneys based upon age. Examination position among the community. of waitlist additions demonstrates that John P. Roberts, MD the number of younger patients ap- At the time of the Congress, new com- proximates the number of kidneys from mittee members and committee chairs younger donors. ASTS has proposed will be appointed. I would hope that using kidneys from donors less than those of you who are interested in get-

Please Note... Spring ASTS Council & Committee Chair Meetings, Friday May 29, 2009 and Saturday, May 30, 2009. Marriott Copley Place, Boston, MA

www.asts.org Chimera Spring 2009 5 ASTS News The ASTS Winter Council and Committee Chair Meeting was held January 14-15, 2009 in Marco Island, FL. Following are select committee news and reports for the meeting.

Ad Ho c Co m p o s i t e Ti s s u e specific. Dr. Hanto reported that SRTR ASTS CME activities. Finally, Ms. Gif- Al l o t r a n s p l a n t a t i o n (CTA) and OPTN/UNOS data were not ac- ford reported that ACCME received an Co m m i t t e e ceptable to ABS due to the lack of an overwhelming response to the call for Dr. Linda Cendales thanked the council audit function and the need to include comments regarding commercial sup- for establishing the new ad hoc commit- quality indicators beyond graft survival. port of CME activities. Due to the level tee and provided background informa- of feedback, ACCME will continue to tion about CTA and the evolution of Aw a r d s Co m m i t t e e discuss the matter and has postponed a the field. Dr. Cendales stated that the Dr. Ginny Bumgardner reported on be- decision until late in 2009. ASTS could benefit the progress of CTA half of Dr. Humar that the deadline for as the complexity of CTA mandates that 2009 research awards had been extended Communications Co m m i t t e e this procedure be driven by surgeons and until January 22, 2009 and a summary of Dr. James Whiting reported that the classified as an organ from a regulatory the 2009 applications will be presented committee continues to look for new standpoint. She presented a mission at the May council meeting. Dr. Bum- ways to engage the membership through statement focused on education, re- gardner also reported that ASTS has the website and other means of commu- search and professional development. received several questions from members nication. He reported that the Decem- interested in applying for the ASTS – ber Chimera issue was in circulation and Am e r i c a n Bo a r d o f Su r g e r y Astellas David Hume Bridge Award that continues to be well received. The com- Dr. Douglas Hanto reported on the pro- did not apply to the NIAID but another mittee is working with Tii to add RSS ceedings at the recent American Board institute within the NIH. The commit- (Real Simple Syndication) feeds to the of Surgery (ABS) retreat. The ABS tee would like to investigate establish- ASTS website. This will allow people to has reviewed the preliminary results of ing a similar relationship with other sign-up to automatically receive website the Association of Program Directors institutes so this award could be more updates based on their areas of interest. (APDS) survey of general surgery pro- encompassing. The council agreed with gram directors and residents regarding the committee and encouraged them to Cr i t i c a l Ca r e Ta s k Fo r c e the resident experience on transplant work with other institutes. Dr. Dinesh Ranjan reported that the task rotations. There were no huge discrep- force is hosting a luncheon symposium ancies between program director and By l a w s Co m m i t t e e at the winter symposium titled “Manage- resident responses to date but the biggest Dr. Stuart Flechner reported the transi- ment of the Wrong Organ for the Wrong issue appears to be with residents that tion to online voting for the quarterly Recipient” to complement the winter have to travel to another institution for membership ballot has increased mem- symposium topic: “The Right Organ the rotation. A follow-up survey with ber participation. The committee is for the Right Recipient.” Dr. Ranjan a control group is performed in two poised to help in the creation of a surgi- reported that ongoing initiatives include years to give the curriculum time to be cal associate committee as needed and the development of unit objectives for implemented and used by residents. The will propose relevant bylaws changes. the online curriculum and a transplant ABS continues to deliberate the concept critical care manual. Dr. Ranjan pre- of recertification with focused exper- CME Co m m i t t e e sented the draft ASTS white paper on tise and has identified two areas that Ms. Kim Gifford reported on behalf of the prerogative of the transplant surgeon ASTS would need to improve before a Dr. Kinkhabwala that ASTS is due for in the ICU care of transplant patients. program could be implemented. To sup- reaccreditation by the Accreditation He asked the council and committee port MOC part 2, lifelong learning and Council for Continuing Medical Educa- chairs to review the document and pro- self-assessment, ASTS would need to tion (ACCME) this year. The National vide feedback so the paper can be final- develop an ongoing activity that could Office will work with Amedco, the CME ized. be assessed such as monthly articles with consultant, to prepare the application. an annual exam. To support MOC part The interview will occur during the Fe l l o w s h i p Tr a i n i n g Co m m i t t e e 4, evaluation of performance in practice, summer with a final decision in Novem- Dr. John Magee presented evaluation individuals would need to participate in ber. The new criteria adopted by the data from the fellows’ symposium and an outcomes database that was surgeon ACCME will require changes to current thanked the Society for its support of

6 Chimera Spring 2009 www.asts.org the meeting. The committee believes collaboration with NATCO, and the council decided that the current experi- this meeting is of great value to fel- recent initiative to attract nurse prac- ence criteria are too broad. The com- lows as it covers topics not addressed titioners (NP) and physician assistants mittee will remove the currency criteria in clinical training and engages fellows (PA). NATCO notified its members of and develop alternate pathways that do early in their careers. If funding can be the new collaboration in October and not endanger senior members. Finally, secured for the 2010, Dr. Magee pro- approximately 70 NATCO members Dr. Mulligan presented two new com- posed the planning committee consist expressed interest in dual membership mittee initiatives, drafting recommen- of Drs. Geevarghese, Collins and Fryer. with ASTS. The ASTS national office dations for combined liver and kidney The council discussed the “Quality vs. will work with these individual NATCO transplantation and standards for evalu- Quantity” program instituted in 2006 members to complete the membership ating and using donors with infection/ and requested that Dr. Magee present process. transmission risks. At the suggestion of detailed information about this program the council, the committee will examine at the next council meeting along with Sc i e n t i f i c St u d i e s Co m m i t t e e the use of kidneys for transplant where committee recommendations regarding Dr. David Gerber presented data from the donor has renal cell carcinoma. continuing this program. the DonorNet follow up survey. While the committee is still in the preliminary Va n g u a r d Co m m i t t e e Hi s t o r i a n Re p o r t stages of their analysis, Dr. Gerber noted Dr. Randall Sung provided an update on Dr. Thomas Peters reported that the that there was an increase since the pre- the 2009 Winter Symposium program videos of the first group of Chimera vious survey in the number of surgeons and associated events. Dr. Sung report- Chronicle honorees are in the final taking the primary calls for organ offers ed that of the 124 abstracts submitted, phase of editing. The design and devel- (up 8%), 66% reported their center had 15 were accepted for oral presentation, 9 opment of the online content is ongo- an effective plan in place for the imple- for mini-oral presentation, 74 for poster ing and ASTS plans to have the first mentation of DonorNet, 75% reported presentation for an overall acceptance two filming sessions available online by no personnel had resigned, 63% consid- rate of 79%. Dr. Sung also highlighted May 2009. Dr. Peters also presented an ered the information more reliable than the special features including the Chi- update on the second taping schedule to the phone-based process (up from 43%) mera Chronicles lecture featuring Dr. take place during the ASTS 9th Annual and 47% rated the system as “good” (up William Pfaff, career development State of the Art Winter Symposium. He from 29% ). Dr. Gerber will work with symposium, standards committee pre- stated that six participants will be filmed the ASTS national office to sort the symposium, business practice seminar, for the Chimera Chronicles library (full data by organ and will provide a final critical care luncheon symposium, FMG report page 20). report at the May Council Meeting. task force event and two satellite sym- posia (full report page 16). Me m b e r s h i p Co m m i t t e e St a n d a r d s Co m m i t t e e Dr. Paul Kuo reported that the Septem- Dr. David Mulligan reported that the Dr. Sung announced the 2010 winter ber 30, 2008 quarter represented the committee had successfully completed symposium will be titled “The Cut- highest number of applications in the the recommendations on standards for ting Edge of Transplant Surgery” and history of the ASTS with fifty-five ap- organ procurement and recommenda- scheduled for January 15-17, 2010 at the plications approved. Overall, member- tions for guidelines for DCD organ Marriott Harbor Beach in Ft. Lauder- ship increased by 12.4% in 2008 and the procurement and transplantation. Dr. dale, FL. The 2010 pre-meeting is titled current count is 1320. Dr. Kuo reported Mulligan submitted both documents to “Clinical Research in Transplantation.” that the committee continues to develop UNOS/OPTN. Dr. Mulligan then pre- strategic approaches to increase and sented revised recommendations for the broaden membership through mailings, definition of a transplant surgeon. The

A full listing of all ASTS committees and their mission can be found at www.asts.org /Society.

www.asts.org Chimera Spring 2009 7 Legislative Report

Ec o n o m y a n d He a l t h Ca r e under the existing program and expand resolved by the last Congress. The bill Do m i n a t e Ea r l y Fe d e r a l Ag e n d a it to include an additional 4 million currently funds a number of agencies The 111th Congress commenced early children (to a total of 11 million) who including the Department of Health & this year to give the new Obama would otherwise be uninsured. The Human Services at 2008 levels under Administration an early start in tackling expanded program will cost the federal a continuing resolution (CR). At the the fiscal woes of the nation. Democrats government an additional $32.3 billion time of this writing, both the House and now hold a substantial majority in both over five years (for a total of over $57 Senate were set to extend the CR for houses of Congress and this reality will billion) on the program. an additional week to allow the Senate likely impede the minority party’s ability time to consider and pass a final bill. to slow or kill legislation, especially Ec o n o m i c Re c o v e r y in the House. Despite this enhanced After over a month of fierce negotiations, The bill provides about $152 billion Democratic control, the 2008 elections Congress passed an economic recovery to labor, health & human services and failed to seat 60 Democrats, thereby package, the American Recovery and education programs, nearly a $6 billion requiring bipartisanship to ensure Reinvestment Act (“ARRA”), which the increase over 2008. Under the current passage of legislation in the Senate. President signed on February 17. To gain omnibus package, HHS receives a 4% This also means the minority party will support from three Republicans in the increase which the Bush Administration keep a powerful negotiating tool to Senate in order to secure passage, the bill had proposed cutting in 2009. achieve its legislative objectives. had to be pared down to a price of $787 The Obama Administration has hit the billion. The bill cost over $900 billion at Health Resources and Services Admin- ground running by tackling a number of one point in the process. istration (HRSA): Within the $7.25 campaign pledges including the expan- billion for HRSA, the Division of Trans- sion of health insurance coverage for Key components of the ARRA include plantation, the agency that oversees children, passing an omnibus spending a $10 billion increase for NIH research and funds the organ allocation system in bill to fund federal programs and agen- funding, $1.1 billion for comparative this country, receives about $24 million, cies through the rest of the fiscal year. In effectiveness research to examine the which is nearly $1.5 million over the addition, an economic recovery pack- clinical and cost effectiveness of particu- 2008 funding level. ASTS and others age that will provide relief to states and lar treatments, and a $19 billion invest- actively sought this additional funding funding for infrastructure projects that ment in Health Information Technology in the transplant community. It is the are designed to stimulate the economy (HIT) through Medicare and Medicaid. first time new federal dollars has been and spur job growth through increased This last provision will significantly appropriated to fund the programs under federal spending. In early March, the boost the amount of resources avail- the Organ Donation and Recovery Im- President fulfilled another campaign able to capitalize the electronic medical provement Act. promise by lifting the federal ban on records platform, providing incentives stem cell research. Depending on which (including out-year penalties for non- National Institutes of Health (NIH): side of the political spectrum one sits, compliance) for physicians and hospitals The bill also provides just over $30 these expenditures are either vital to to adopt HIT within the next decade. billion for NIH, over $1 billion re-start the economy while tackling more than the budget request. After difficult health care problems, or they Other provisions include a nearly $90 accounting for this increase and the represent a huge and unnecessary shift of billion boost for state Medicaid programs, additional temporary funding in the debt onto future generations. an extension to COBRA insurance cov- recent stimulus legislation, NIH will erage for employees who lose their jobs have $11 billion over their existing St a t e Ch i l d r e n ’s He a l t h during the recession, and a repeal of the budget to spend over the next two years. In s u r a n c e Pr o g r a m 3% withholding tax on Medicare pay- Before this infusion, funding for NIH On February 4, the House passed legisla- ments to health care providers. projects had been critically low and now tion to reauthorize and expand the State NIH will be able to fund almost 10,600 Children’s Health Insurance Program FY 2009 Om n i b u s new research grants. (SCHIP). SCHIP was created in 1997 App r o p r i a t i o n s Bi l l to provide health care coverage for The early Congressional start allowed The National Institute of Diabetes, children in modest-income families that for a behind-closed-doors conference on Digestive and Kidney Diseases is pro- earn too much to qualify for Medicaid, the remaining 2009 spending bills. On vided $1.76 billion in funding, almost but not enough to afford private insur- February 25, the House passed a $410 $60 million more than in 2008. ance. This legislation will protect cov- billion FY 2009 omnibus spending bill, erage for those children already covered finishing up the work that could not be

8 Chimera Spring 2009 www.asts.org The National Heart, Lung, and inefficiencies; put the nation on a path negligible savings and with no policy Blood Institute is provided just over to universal coverage; make health explanation). $3 billion, an increase of $79 mil- plans portable; allow Americans to keep lion in funding. employer-based plans; improve safety; The new budget would also create a reg- and make the plan pay for itself. ulatory pathway to allow the Food and The National Institute of Allergy Drug Administration to approve generic and Infectious Diseases is provided Health Care Reform Reserve Fund: or follow-on versions of biotechnology $4.4 billion, an increase of $138.8 The President’s budget proposes to cre- drugs. The budget documents state that million in funding. ate a $634 billion “reserve fund” over the Administration will support FDA’s the next decade to finance expanded efforts to allow Americans to buy safe Pr e s i d e n t Ob a m a ’s FY health insurance coverage and oth- and effective drugs from other countries 2010 Bu d g e t er health care investments. The reserve (“drug reimportation”). Other savings On Thursday, February 26, in prelimi- fund is likely a little more than half the would come from streamlining certain nary budget documents (a full proposal cost of health care reform that is ex- programs, such as linking Medicare phy- will be released in April), President pected to eventually provide universal sician payments to the quality of care Obama released a summary of his $3.55 healthcare coverage. Congress will be provided. trillion FY 2010 federal budget. The expected to find additional savings to budget was termed “honest” by Admin- make up the difference. Fixing the Physician Fee Schedule: istration officials because it eliminated The budget proposal includes $329.6 budget devices used by previous admin- The reserve fund would be paid for billion over the next 10 years to fix the istrations to disguise the magnitude of through tax increases on high income Medicare physician fee schedule prob- federal outlays, in particular, war spend- Americans and Medicare cuts. Ap- lem. If adopted by Congress, this would ing. This proposal contains a number proximately half of the fund would be effectively eliminate the enormous defi- of big-ticket spending items as well as generated by increasing taxes on couples cit and scheduled Medicare physician tax increases on top income brackets, earning more than $250,000 a year and payment cuts of 40% that result from both of which quickly came under fire in individuals earning more than $200,000 the Sustainable Growth Rate “SGR” Congress and in the news media. The a year. Cuts in subsidies to Medicare formula over the next seven years. White House asserted that it had closely managed care plans and changing the While the full impact is hard to gauge, reviewed the budget and found $2.2 tril- Medicare Advantage program so that such a large financial commitment lion in savings over ten years to help pay plans bid to provide Medicare benefits would seem to meet the AMA’s desire for many of its new initiatives. and the program pays based on the aver- for a realistic budget baseline to solve age bid are expected to yield $175 bil- this problem and assumes Congress will As is the case every year, however, the lion in savings over 10 years. continue to protect against further SGR President’s proposal is just the first step cuts. In addition, the Administration in a lengthy budget process and it is not Other Health Reform Funding: Other would support comprehensive, fiscally a law but a non-binding resolution that sources of funding include savings responsible, reforms to the SGR pay- frames consideration of the many ap- from “bundling” payments for hospitals ment formula and moving to a system of propriations bills that fund the agencies and post-acute care services ($17.8 better incentives for high-quality care and programs of the federal government. billion)—a very controversial proposal rather than simply more care. In years’ past, Congress has not adopted that some say is unworkable—reducing many of the President’s proposals in the hospital payments for patients who are Cancer: The budget also calls for the budget process. readmitted to the acute care hospital doubling of funding for cancer research, ($8.4 billion), linking a portion of primarily through the National Insti- Health Care Reform: As in other ar- Medicare payments to the quality of tutes of Health. It also accelerates the eas, the Administration’s budget does care delivered as hospitals ($12 billion), adoption of electronic health records, not contain many specifics about the increased Medicaid drug rebates ($19.6 and would create a nurse home visita- President’s plan to overhaul health billion), and increased Part D drug pre- tion program within the Department of care. However, the Administration did miums for higher income beneficiaries Health and Human Services (HHS). outline eight principles for a healthcare ($8.1 billion), amongst other cuts. In overhaul, including: reduce the cost addition, the budget calls for unspecified of premiums and protect families from restrictions on physician owned hos- bankruptcy as a result of health bills; pitals and incentives for physicians to Legislative Update invest in prevention; reduce waste and administer flu vaccinations (both with Continues on page 11 www.asts.org Chimera Spring 2009 9 Regulatory & Reimbursement Update

CMS Co n s i d e r s Tr a n s p l a n t tiered DRG structure on the grounds CMS Ou t l i n e s It s Vi s i o n f o r Ce n t e r App e a l s Ba s e d o n that it would have a disruptive impact Im p l e m e n t i n g “Va l u e Dr i v e n ” “Mi t i g at i n g Fa c t o r s ” on transplant center financial opera- He a l t h c a r e Transplant centers that have been de- tions because of the significant disparity CMS recently posted its “roadmap” for nied certification for failure to meet the in payments between the low and high implementing “value driven” health- new certification standards can seek re- complexity procedures. CMS did not care in the Medicare Program. This view based on “mitigating factors.” This agree, stating that it had insufficient data document focuses on the steps involved review focuses on considerations outside under the new MS-DRG system to justi- in implementing a “Value-Based Pur- of the survey criteria, which may justify fy any changes. Now that the new DRGs chasing” (VBP) approach to Medicare failure to meet a particular condition. have been in place for over a year, ASTS payment. A careful reading of this docu- This review is conducted by the CMS intends to collect and analyze transplant ment, posted at http://www.cms.hhs. central office, in order to assure that a center Medicare data to assess the ac- gov/QualityInitiativesGenInfo/downloads/ consistent standard is applied through- tual impact of the DRGs on transplant VBPRoadmap_OEA_1-16_508.pdf pro- out the country. By contrast, the centers. If the data confirms ASTS’s vides a glimpse of the types of reforms reviews conducted by the survey agen- belief that this contributes to financial that are likely to be considered in the cies, under the supervision of the CMS instability due to widely fluctuating pay- context of health care reform over the Regional Offices, focuses on whether a ment amounts from year to year, ASTS coming year. center’s plan of correction adequately will take this data to CMS in a renewed addresses the deficiencies cited as the effort to change policy. Adoption of a VBP system for compen- result of the survey. sating physicians is likely to be acceler- Co s t s o f Pa n c r e a t a Ac q u i r e d ated when CMS submits to Congress As of February 1, 2009, CMS reports that f o r Is l e t Ce l l Tr a n s p l a n t s a report required by Section 131(d) of it completed action on mitigating factors The confluence of a number of CMS the Medicare Improvements for Patients requests from 21 transplant center pro- policies has resulted in a significant cost and Providers Act (MIPPA), a statute grams. Nine of the requests (43%) were increase in the standard organ acquisi- that requires the Secretary to develop approved. Seven of the nine were related tion charge (SAC) for pancreata ac- a plan to transition to a VBP program to patient or graft outcomes, all seven of quired for use in conjunction with islet for Medicare payment for professional those programs were able to demonstrate transplants. This cost increase has con- services. No later than May 1, 2010 substantial program improvements that tributed to a significant reduction in islet CMS is required to submit a Report had been implemented, and institution- cell transplant research. In December to Congress containing the plan with alized, significant evidence of improved 2008, ASTS spearheaded a meeting with recommendations for legislation and outcomes subsequent to the changes, CMS to discuss the problems created administrative action. To meet this and projected compliance with outcomes by CMS policies in this arena. At the statutory requirement, CMS has formed requirements based on current outcomes. meeting, ASTS was advised that CMS an internal workgroup, which will be An effective QAPI program and a thor- has taken the position that the agency evaluating the implications of a number ough root cause analysis were also cited is statutorily required to apply the same of demonstration projects that have by CMS as important in reaching a posi- cost reporting principles to islets as it been ongoing. tive decision. does to whole organs. For this reason, it is anticipated that this issue likely will While VBP is beginning with efforts ASTS t o Re v i e w Im p a c t o f not be resolved without considerable to incorporate incentives for quality Ne w Li v e r a n d He a r t DRGs o n additional effort by ASTS and others reporting and performance into the Tr a n s p l a n t Ce n t e r s dedicated to islet cell transplantation current payment system, it is clear that This is the second year of the new MS- research. At this time, ASTS is putting CMS envisions VBP as an approach DRGs for heart and liver transplants. together a plan to convince the agency that would ultimately result in com- Beginning in FY 2008, CMS imple- to reverse its current position. It is pos- pletely new payment mechanisms that mented a new DRG system that in- sible, if not likely, that the plan will presumably would replace the current cluded two separate DRGs (one for high require legislative outreach. Physician Fee Schedule in many cases. complexity cases and another for low These payment systems would be struc- complexity cases) for liver transplants tured to include shared savings models and for heart transplants. ASTS had between CMS and providers. To support urged CMS not to implement the two- these new payment systems, CMS would need to consider appropriate modifica-

10 Chimera Spring 2009 www.asts.org tions to the physician self-referral rules and improvement operation. That dem- Legislative Update so that hospitals and other institutional onstration started in October 2003, and Continued from page 9 providers could reward physicians for has documented substantial improve- improving quality and efficiency in their ments in the quality of inpatient care. The increased spending and the pro- local healthcare delivery settings. As an The demonstration is measuring and posed elimination of major tax cuts drew example, CMS could develop units of providing bonus incentives for improv- immediate opposition to the Obama Ad- payment that are based on broad bun- ing quality of care in five clinical areas: ministration’s budget outline from not dles of hospital and physician services acute myocardial infarction (AMI), just mainstream Republicans, but also which eventually could even include pneumonia, heart failure, CABG, and Republican and Democratic moderates entire episodes of care. Physicians and hip and knee replacement. as well as the many groups facing cuts hospitals could then decide how best to in his budget. Whether Congress will provide these services in a more efficient In addition, transplant surgeons ulti- be able to answer the Obama propos- manner on a patient-by-patient basis, mately may be affected by the results als with equally ambitious legislation and could allocate the payment among of the Medicare Hospital Gain-sharing at a time where there are other huge themselves in a way that allowed each Demonstration, authorized by Section problems facing the nation is an open to share in the savings. 5007 of the Deficit Reduction Act. question at the moment. But, whatever This provision requires the Secretary of the shortcomings of the new budget This model is already being tested in the Health and Human Services to establish proposal, the onus will be on critics and current CMS Acute Care Episode (ACE) a gainsharing demonstration program to lawmakers to propose and pass alterna- demonstration. In this demonstration, an- test and evaluate arrangements between tives. nounced in January, 2009, five hospitals in hospitals and physicians designed to the South Central states will participate in improve the quality and efficiency of ASTS and others interested in organ a project in which they are paid global fees care provided to beneficiaries. The dem- donation and transplantation-related for cardiac and/or orthopedic procedures. onstration allows hospitals to provide policies will continue to support legisla- Meaning that they will be paid a single fee gainsharing payments to physicians that tion left undone from the last Congress for the hospital facility fee and for all of represent a share of the savings incurred while tackling new issues such as health the physician fees, including the surgeon, as a result of collaborative efforts to care and Medicare reform. These priori- any consulting physicians, radiologists, improve overall quality and efficiency. ties include increased federal funding anesthesiologists, and other physicians/ In the absence of this DRA authority, of organ donation and transplantation practitioners included in the care of the gainsharing is restricted by the civil programs, the removal of financial dis- patient. Also, the participating hospitals monetary penalty law, which prohibits incentives for organ donation, an exten- and physicians will be permitted to use hospitals from rewarding physicians for sion of Medicare immunosuppressive gainsharing to improve incentives for reducing services to patients, even if drug coverage, and organ donor registry collaboration. Quality will be measured such reductions are limited to duplica- legislation. through a series of reported process and tive services or otherwise represent im- outcome measures, including several that provements in quality. By Peter Thomas, Esq. focus on surgical infections such as selec- Legislative Counsel, and tion and administration of antibiotics and ASTS will be monitoring movement Adam Chrisney, Legislative Director deep sternal wound infection rate. both at CMS and on the Hill related to Powers, Pyles, Sutter & Verville, PC VBP initiatives, and will keep ASTS Another important demonstration posted on new developments in future project noted in the “Roadmap” is the issues of Chimera. Premier Hospital Quality Incentive Demonstration, which includes ap- By Diane Millman, Esq. and proximately 250 hospitals in 38 states in Rebecca Burke, Esq. collaboration with Premier, Inc., which Powers, Pyles, Sutter and Verville, PC operates a large quality measurement ASTS Regulatory Counsel

Visit the ASTS website for additional advocacy efforts at www.asts.org /Advocacy

www.asts.org Chimera Spring 2009 11 OPTN/UNOS Corner

Pu b l i c Co m m e n t Pe r i o d from the 2008 Declaration of Istanbul The OPTN UNOS Regional Council- En d i n g So o n regarding transplant tourism and organ lors serve two-year terms. Including Eight proposals for new or amended trafficking. In other action, the Board those recently elected and those con- OPTN policies and bylaws are currently endorsed a statement proposed by the tinuing service, Councillors for the 2009 out for public comment. The submis- OPTN/UNOS Ethics Committee that term will be as follows: sion deadline is Friday, April 24. The living donation from prisoners may be sponsoring committees will convene to ethical in certain circumstances, such as • Region 1 – Paul E. Morrissey, consider public comments and deter- to a family member. M.D., Rhode Island Hospital mine whether the proposals should be • Region 2 – Lynt B. Johnson, forwarded to the OPTN/UNOS Board An executive summary of Board ac- M.D., Georgetown University as is, amended or withdrawn. Propos- tions will be posted as soon as they are Medical Center als currently under consideration may available on the OPTN web site in the • Region 3 – George E. Loss, Jr., be brought to the OPTN/UNOS Board following location: http://www.optn.org/ M.D., Ph.D., Ochsner Founda- at its June 2009 meeting. To view the members/executivesummary.asp. A notice tion Hospital proposals and learn about ways to offer of policy changes resulting from the • Region 4 – John A. Goss, comments, visit the OPTN web site: Board meeting will also be distributed M.D., Methodist Hospital, http://www.optn.org/policiesAndBylaws/ via broadcast e-mail to contacts includ- Houston publicComment/proposals.asp. ing transplant program directors and • Region 5 – Chris E. Freise, transplant administrators. M.D., FACS, UC San Fran- Su m m a r y 2008 Da t a Re l e a s e d cisco Medical Center Preliminary national statistics describing OPTN/UNOS Bo a r d Of f i c e r s • Region 6 – Jorge D. Reyes, organ donation and transplantation are a n d Re g i o n a l Co u n c i l l o r s M.D., University of Washing- now available for the whole year of 2008. f o r 2009 Te r m ton Medical Center The data are subject to change based OPTN/UNOS members recently • Region 7 – John R. Lake, upon future submission or updates. elected officers and Board members to M.D., University of Minnesota fill vacancies for the 2009 term. The Medical Center As of press time the totals of both living new officers and members will begin • Region 8 – Michael D. Voigt, and deceased donors, as well as trans- their terms after the conclusion of M.B., Ch.B, University of plants from these donors, appear to have the OPTN/UNOS Board of Directors Iowa Hospital and Clinics decreased slightly compared to 2007. In meeting on June 23. The officers for the • Region 9 – Patricia A. Shei- 2008, there were 7,989 deceased donors 2009 term are as follows: ner, M.D., Westchester Medi- and 6,215 living donors recorded. In cal Center all, 27,958 transplants were performed: • President – James J. Wynn, M.D., • Region 10 – Lynn Driver, 21,741 from deceased donors and 6,217 Medical College of Georgia CPTC, Indiana Organ Pro- from living donors. The years 2007 and • Vice President/President Elect curement Organization 2008 are the only two since 1988, when – Charles E. Alexander, RN, • Region 11 – Carl L. Berg, the OPTN began reporting national M.S.N., M.B.A., CPTC, Living M.D., University of Virginia data, where annual transplant totals Legacy Foundation of Maryland Health Sciences Center have decreased from the previous year. • Vice President of Patient and Do- To access a number of more detailed nor Affairs – M. Jill McMaster, For a list of all members newly elected data reports, or to submit a data request M.A., CAPT USNR (Ret.) to the OPTN/UNOS Board, visit the to UNOS, consult the OPTN web site: • Immediate Past President – Robert OPTN web site: http://www.optn.org/ http://www.optn.org/data. S.D. Higgins, M.D., M.S.H.A., news/newsDetail.asp?id=1218. Rush University Medical Center OPTN/UNOS Bo a r d Ac t i o n s • Secretary – Mitchell L. Henry, By Joel Newman The OPTN/UNOS Board of Directors M.D., Ohio State University Med- Assistant Director of Communications met March 2 and 3 in Houston. Among ical Center UNOS its key actions, the Board adopted a • Treasurer – Art L. Thomson, series of definitions differentiating be- M.A., Cleveland Clinic Founda- tween concepts such as organ traffick- tion ing, transplant tourism and travel for transplantation. These definitions stem

12 Chimera Spring 2009 www.asts.org The ASTS Provides Input Into the UNOS/OPTN Kidney Allocation Proposals

ive years ago, the Organ Procure- consideration for the more looming qual- with long projected life spans could be to ment and Transplantation Network ity of life decisions patients face while on require that deceased donor kidneys from F(OPTN) charged its Kidney Trans- dialysis. donors less than 35 years old be preferen- plant Committee to perform a complete tially offered to candidates less than 35 review of kidney allocation policy. This 2) The KAS proposal was a donor driven years old. Even though this is an arbitrary process resulted in the issuance of a Re- system that would have significantly approach, this simple modification would quest for Information (RFI) from UNOS limited patients’ autonomy. Under the be consistent with the existing, also arbi- in August of 2008 (The full text of this proposal, the risk profile of the donor trary, policy that mandates kidneys from document can be found at www.optn. would determine how much weight dialy- donors less than 35 years of age be prefer- org.) The RFI described a new Kidney sis time and LYFT were given in the final entially allocated to pediatric candidates allocation score (KAS) that would be KAS. This means that the system would who are equally arbitrarily defined as less calculated at the time of an organ offer determine the quality of kidney being than 18 years of age at the time of listing. using parameters for donor risk, time on offered to individual patients and if the Geographic differences could also be ad- dialysis and life years gained from trans- candidate refused a given offer, it would dressed by allowing regional sharing for plant (LYFT). Although many found be unlikely that a better offer would ever kidneys from donors less than 35 that are merit in using dialysis time and incorpo- come along since a given candidate’s allocated to candidates less than 35 years rating a continuous scale for donor risk LYFT would decrease as the candidate old. Importantly, this would be a very assessment, there was considerably more ages. Moreover, since there would be no simple, easy to understand, system. concern directed at the proposed use of way to predict what type of donor would LYFT to rank patients on the list. The be offered, there would be no way to This change might reduce the demand for ASTS formed a task force and developed predict which waiting candidates were living donor transplantation as was seen a comprehensive response to the UNOS/ most likely to be offered the next organ. when the pediatric policy was activated. OPTN request (http://www.asts.org// Because of this, transplant centers would Modifications could be made so that some Advocacy/Regulatory04.aspx). Subse- have much more difficulty managing period of waiting was required for the quently, members of the ASTS task force their lists and would not be able to offer less than 35-year-old candidate before presented the Society’s viewpoint at the any realistic estimate of waiting time for they achieve the priority for the less than public Forum held in St. Louis on January their patients. 35-year-old donor kidney analogous to 26, 2009. the pediatric waiting time policy1 in ef- 3) Another major concern with calcu- fect now. Th r e e m a i n c r i t i c i s m s r a i s e d i n t h e lating LYFT is that the models used for ASTS r e s p o n s e estimating pre and post-transplant sur- Another, not necessarily mutually exclu- 1) The underlying demand for kidney vival did not meet the usual standards for sive, change could be to require that all transplantation, and therefore the foun- mathematical model predictive accuracy. candidates indicate what range of donor dation for kidney allocation, is driven by The whole process highlighted that the risk (DPI) he or she is willing to accept. different motivations than exist for liver OPTN/SRTR data do not discriminate By allowing patients to designate the DPI or lung transplants where allocation pol- well among various important risk covari- they are willing to accept before a donor icy is heavily weighted toward mortality ates such as cardiovascular disease, sever- organ is offered, the system becomes a risk. In contrast to these other transplant ity of diabetes, and some would argue, patient-based system. Some critics have types, candidates for kidney transplanta- race. voiced concern that under such a system, tion do not have immediate short-term candidates might all designate broad mortality risks because of the availability Ultimately, the ASTS and others opined ranges of donor risk that they are willing of dialysis. Their motivation for seeking a that the LYFT-based KAS proposal was to accept. This is precisely why kidney kidney transplant is much more driven by much too complicated and too opaque allocation is different. Many candidates the immediate gains in quality of life that to be implemented for kidney allocation are more concerned about their quality of a kidney transplant can offer. Therefore, policy. life and being given the opportunity for allocation policy based on LYFT, where any kidney with reasonable risk charac- long term survival estimates are used to Al t e r n a t i v e App r o a c h e s teristics rather than getting the one with distinguish between high and low priority The ASTS suggested that one option the best match to their own projected patients on the list, does not have much for directly allocating kidneys with long lifetimes. If they are well informed in relevance and does not offer adequate projected function times to recipients making such a decision (another ad- www.asts.org Chimera Spring 2009 13 vantage of this proposal is that it would, out of necessity, require that candidates ASTS Welcomes New Staff are well informed about the spectrum of donor quality that could be offered to them), system should prevent this. To ASTS Welcomes address concerns that some candidates with very limited survival times might Serge Shahabian choose to designate broad ranges of Manager, Business Development and Policy Initiatives donor types and thereby open the pos- sibility for receiving a long functioning Serge Shahabian is an accomplished kidney, we could just require that candi- marketing professional with a dates greater than a certain age cannot wide variety of experience in all designate accepting kidneys with the facets of business planning, market lowest DPI. This type of patient driven research, competitor analysis, system may not achieve an overall in- promotions, market strategy, cycle crease in life-years from transplant, but it time reduction, request for proposals will preserve patient autonomy and in- and business development. Mr. dividual justice, and would require much Shahabian comes to us from The less reorganization and reeducation. U.S. Chamber of Commerce, the world’s largest business federation, Change always engenders fear. Whatever where he spent the last three years changes in kidney allocation policy are directing the research and analysis put forward, open, and frequent commu- team in support of multiples sales nication, presentation and publication in channels. Previously, he held the peer-reviewed venues and careful plan- position of a Market researcher at ning for transition can go a long way to Computer Systems Center, Inc. (CSCI), a provider of innovative business and allay these fears. The American Society product solutions to the Federal Government, where he developed strategic of Transplant Surgeons’ membership business plan for commercialization of in-house computer software. Mr. interacts with kidney transplant candi- Shahabian has Bachelor of Science in Marketing from the Pennsylvania State dates face to face everyday and are direct University Smeal College of Business. messengers to patients for explaining al- location policy for every type of deceased Serge’s primary role will be to work with the ASTS Business Practice Advisory donor transplant. We are pleased to be and help grow revenue-generating initiatives for the Society. In addition, he ongoing, active participants in future serves as staff liaison for legislative, regulatory and reimbursement committees/ policy development. projects. By Richard B. Freeman, Jr., MD Vice Chair for Research Department of Surgery Professor of Surgery Tufts Medical Center

ASTS Compensation Report Have you taken the opportunity to download the ASTS comprehensive compensation study for transplant surgeons practicing within the United States?

This fifty-page report allows ASTS members to compare their salary and benefits with their peers at the staff surgeon and program director level. The data is aggregated by region, practice type, personal and center volume and primary practice in order to provide the most comprehensive data. For ASTS members in leadership positions (Division Chief, Transplant Center Director or Institute Director/Chief) a Leadership Report is also available. This seventy-page document expands on the base report to include compensation data for the leadership levels. To receive the Leadership Report, send a letter on institutional letterhead confirming your leadership status to the ASTS National Office.

Distributing this report to non-members is prohibited. Interested parties should contact the ASTS National Office for access to the report.

14 Chimera Spring 2009 www.asts.org Removing Disincentives for Living Donors Is your transplant center participating? Why not? There is no better time! The NLDAC provides up to $6,000 for eligible living donors and their companions to travel to the transplant center for the evaluation, surgical and medical follow-up trips.

As of March 2009 • 120 (approximately 50%) Transplant Centers have filed a NLDAC application • 86% of applications are approved • 415 applications have been approved for funding • $2,900 is the average amount approved per donor • 189 donors have completed their donor surgery using NLDAC funding

Did you know? • NLDAC can assist with travel to or from U.S. Territories such as Guam and PuertoRico • NLDAC has budgeted 1.3 million dollars for donor travel in 2009 • NLDAC staff are available to train transplant center staff how to file an application • NLDAC is a funded by a DoT grant awarded to ASTS and the U of Michigan

Donors Appreciate the Assistance! Being an out of state donor, I really thought it would be a hardship. The NLDAC made it such an effortless decision. I truly believe if people knew about what you offer, more living donors would come forward. Thank you for all your support. Katherine - Cleveland Clinic Foundation

Thank you for the financial assistance. We wouldn’t have been able to proceed with the transplant without the support. Your assistance made it possible for our family members to be together during times of need. Nalee - Medical College of Georgia Hospital National Living Donor Assistance Center 2461 S. Clark Street Suite 640 Arlington, VA 22202 Ph 703-414-1600 Fax 703-414-7874 [email protected] www.livingdonorassistance.org ASTS 9th Annual State of the Art Winter Symposium The Right Organ for the Right Recipient January 16-18, 2009 Marco Island Marriott, FL

Held in Conjunction with the NATCO Symposium for the Advanced Transplant Professional

This is my favorite meeting…this meeting allows you to meet people in the inner circle without the distraction, as when attending larger meetings in big downtown cities. This meeting provides close discussion on immediate issues. – Hoonbae Jeon, MD, University of Kentucky Medical Center-Chandler

The Program Planning Committee of American Society of Transplant Surgeons convened another triumphant symposium focusing on the complex concept of matching donors to recipients. This CME event engages multidisciplinary education planned for and by the entire transplant team and is designed to address performance-based gaps in learning with a commitment to quality improvement. Each year the Planning Committee does an exceptional job at addressing the educational objectives of the symposium through a keynote address, debates, oral abstract presentations, poster presentations, video presentations and other special events.

The educational goals were for participants to 1) develop an understanding of how donor and recipient matching may affect outcomes, 2) learn a variety of practices employed in matching donors to recipients, 3) understand the ethical principles which affect the selection of recipients for high-risk donors, and 4) become conversant with the issues surrounding the use of organ allocation policy to match donors and recipients.

When we surveyed attendees on their symposium experience, this is what they had to say.

[The Winter Symposium] is an excellent venue for young surgeons to rub elbows with icons in transplant surgery… with contemporaries changing the course of transplantation over the next generation. One of the main highlights of the meeting is the ability to watch the heavy weights debate the ethically charged issues at this juncture in transplantation. – Burnett “Beau” Kelly, MD, Vanderbilt University Medical Center

This meeting is an excellent learning resource. It’s always interesting to learn about someone else’s perspective on transplantation techniques. The meeting encourages participation and time for feedback and discussion. In addition, the symposium is a great opportunity to meet up-coming leaders and to network with other transplant surgeons. – Dinesh Ranjan, MD, University of Kentucky Medical Center

This is my first time attending the academic conference after becoming an attending. I wanted to see how the ASTS works and broaden my insight into the Society. – Dong-Sik Kim, MD, University Hospital of Cincinnati

Attendance Save The Date 2009…the highest registrants in Symposium history! ASTS 10th Annual State of the Art Winter Symposium 2009 2008 344 ASTS Attendees 306 ASTS Attendees 110 NATCO 112 NATCO January 15-17, 2010 454 attendees Total 418 attendees

10 Exhibits 6 Exhibits New Location! 8 Additional Events 3 Additional Events 2 Satellite Symposia Marriott Harbor Beach Fort Lauderdale, FL

ASTS 9th Annual State of the Art Winter Symposium The Right Organ for the Right Recipient January 16-18, 2009 Marco Island Marriott, FL

ASTS, Meeting the Educational Needs of the transplant community

Event Highlights… Special Why Do We Need Them and How Do We Maintain Them? The intent of the Pre-Symposium was to provoke dialog among the transplant community Acknowledgements concerning what types of standards are required and/or needed in organ transplantation. ASTS recognizes the contributions of the The purpose of the ASTS Standards on Organ Transplantation Committee is to develop Program Planning Committee, Exhibitors, high standards for organ procurement, transplantation, and patient care, and to educate the Corporate Supporters, Corporate Sponsors, membership about existing or new regulations, standards and policies under development. In recent years, the controversy surrounding standards has amplified concerning performance and Moderators, and Presenters who helped make practice. The Standards committee thought it beneficial to bring together subject matter and this educational opportunity a success. develop a clear understanding of where transplantation stands by way of standards and future Thank you! goals. ASTS Program Transplant Center Models: From Design to Practice Planning Committee Focusing on their mission, The ASTS Business Practice Committee used a series of Program Chair, Randall S. Sung, MD presentations to help participants develop an understanding of transplant center models, payer Senior Advisor, Dixon B. Kaufman, MD, PhD and inter-provider relationships, and define key issues in total integration and partial integration models. In addition, the surgeon compensation process and comparative data were presented. Peter L. Abt, MD Practical Approach To Grant Writing Dev M. Desai, MD, PhD Defining and promoting training and the career-long education of members is important to Catherine Garvey, RN, BA, CCTC ASTS. The Career Development Seminar addressed a critical aspect of transplantation science Dorry L. Segev, MD and medicine essential in securing funding and advancing academic careers. Junior members Thomas Waddell, MD, PhD rarely receive the adequate training needed to submit a competitive application. During the seminar, attendees gained insight on how to develop a fundable grant through a systematic approach and information about available funding mechanisms from representatives of leading funding agencies. Special thanks to the ASTS Vanguard Committee for their insight. Wrong Organ for the Wrong Patient, Critical Management Options Dr. Dinesh Ranjan heads up the ASTS Critical Care Task Force. Dr. Ranjan and other committee members put together a Critical Care Luncheon Symposium designed to fulfill the need for specialized critical care in transplantation. ransplantT critical care looks at end stage organ disease, anesthetic and ICU management, and remote postoperative management. The symposium specifically addresses optimization of medical management of elderly kidney transplant recipients with cardiac disease receiving ECD kidneys, along with identifying key strategies in transplant recipients with compromised organ function such as allograft pancreatitis or small-for-size liver transplantation. Lastly, the symposium addressed how to define and diagnose portopulmonary hypertension in patients undergoing liver transplantation and develop in depth knowledge of appropriate treatment modalities during the perioperative phase. Opportunity Knocks Luck or great planning paid off for prospective transplant fellows. Those in attendance at the Winter Symposium got an integral opportunity to interact with current ASTS Abdominal Fellowship Training Program Directors and to obtain information about applying for and participating in an ASTS Accredited Fellowship Training Program. Members of the ASTS Fellowship Training Committee felt it important to reach out to upcoming surgeons, help direct their careers and convey the importance of interacting with other colleagues. Advancing Transplantation Science and Medicine ASTS recognizes outstanding abstracts submitted each year through oral presentations, posters, and videos. Thank you to everyone that submitted an abstract.

Webcasts of Presentations Can Be Found at www.asts.org / Research & Education

www.asts.org Chimera Spring 2009 17 ASTS 9th Annual State of the Art Winter Symposium The Right Organ for the Right Recipient January 16-18, 2009 Marco Island Marriott, FL

2009 Francis Moore Excellence in Mentorship in the Field of Transplantation Surgery Award

Congratulations to Dr. Arthur J. Matas, University of Minnesota and Dr. Robert L. Jenkins, Lahey Clinic, recipients of the 2009 Mentorship Award. The Vanguard Committee created the award to distinguish exceptional efforts of established surgeons for their mentorship, leadership, and stewardship of fellows and junior faculty. The award cultivates admirable mentorship and acknowledges the time and effort required to advance the careers of new investigators and clinicians. The award was presented during the annual Vanguard Committee Reception. This is a nomination-based award.

Dr. Arthur Matas has been more than a mentor for me. He is an example of compassion, commitment to education and research, integrity and leadership: an example, which goes beyond the training and stays for life. Unique of Dr. Matas, are his silences. You learn more from what he does not say than from what he does say. No words can define his efforts for continuous improvement and advancement of the people working with him. – Massimo Asolati, MD, Dallas VA Medical Center

I first came to know Dr. Jenkins over 6 years ago when I was a general surgery resident rotating through the liver transplant service. Since then he has had a tremendous impact on the development and refinement of my surgical decision-making as well as my surgical technique. Dr. Jenkins simplifies every step and teaches how to operate with efficiency. In the operating room, he is patient and allows the fellows or residents to find their way through the case with his guidance. – Khashayar Vakili, MD, Lahey Clinic

Dr. John S. Najarian, Professor of Surgery, Regents Professor Emeritus, University of Minnesota was the keynote speaker for the awards ceremony. Dr. Najarian, considered a mentor and pioneer in the field, formed one of the world’s largest transplant programs, which has now performed more than 7,000 kidney transplants; more than 2,500 pancreas transplants; and hundreds of heart, liver, lung, islet, bowel, and combined transplants. Under his leadership, the Minnesota program pioneered innovative and difficult types of transplants; achieved Dr. Arthur J. Matas & Dr. Roger L. Jenkins, Dr. John P. Roberts, ASTS President and Award Recipients Dr. John S. Najarian and wife, Mignette, unequaled success with diabetic, pediatric, and older University of Minnesota patients; and made major research, clinical, and educational contributions to the field of surgery. Dr. Najarian is a member of a long list of surgical societies and has received numerous honors for outstanding achievements in transplantation nationally and internationally. Dr. John Najarian was the 1999 recipient of the ASTS-Roche Pioneer Award. One of his greatest honors is the 2004 Medawar Prize. Dr. Najarian became a Medawar Laureate for his monumental contributions to immunobiology, experimental transplantation, and clinical transplantation The Prize is widely deemed the world’s most prestigious award for outstanding achievement in organ transplantation (University of Minnesota, Biographical Sketch, 2008). 2009 ASTS Vanguard Prize Andrew M. Cameron, MD, PhD, Johns Hopkins Medical Institute and Reza F. Saidi, MD, Massachusetts General Hospital are the 2009 ASTS Vanguard Prize recipients. The Vanguard Prize recognizes and honors ASTS junior members for their efforts in basic and clinical research. The award identifies the best clinical and basic research manuscripts from young investigators in the previous year. The awards were presented during Winter Symposium. Congratulations to both recipients for Dr. Andrew M. Cameron, MD, PhD Award Dr. Reza F. Saidi, MD, Award Recipient outstanding publications. Recipient

18 Chimera Winter 2009 www.asts.org ASTS 9th Annual State of the Art Winter Symposium The Right Organ for the Right Recipient January 16-18, 2009 Marco Island Marriott, FL Symposium Highlights

www.asts.org Chimera Spring 2009 19 ASTS History Corner The Chimera Chronicles: Great Stories in Transplant Surgery

Everybody always talks about the good things and how well things are and how good results are and I think the current generation of transplant surgeons needs to know that these good results were built from a fire of disappointment; from years of struggling and failures at multiple centers and whose leaders because of their per- severance, and I will repeat that, because of their per- severance and belief in the discipline, put those failures behind them and kept moving forward. James Cerilli, MD William Pfaff, MD – James Cerilli, MD, Retired Transplant Surgeon

In 2008, ASTS began recording living legacies in transplantation. ASTS currently has over 75 mem- bers of the Society designated as “senior” status. While many of them have retired, it is important that their contributions are remembered, recorded, to serve as an inspiration to the new generation of surgeons, physicians, and transplant personnel. Arnold Diethelm, MD Richard Simmons, MD The second Chimera Chronicles filming took place during the ASTS 9th Annual State of the Art Win- ter Symposium. The stories they told were amaz- ing. You can view them on the ASTS website late spring. The website will also display a photo library.

The recordings will become an annual event, to take place during the ASTS Winter Symposium. John Najarian, MD H. M. Lee, MD

In Memoriam Andrew Novick, MD ASTS would like to recognize one of its long time members, Dr. Andrew Novick, a renowned Urologist and Chairman of the Glickman Urological and Kidney Institute at the Cleveland Clinic. He was an ASTS member since 1977. ASTS was estab- lished in 1974. Novick passed away Saturday, Oct. 18, 2008 from complications of lymphoma. Novick joined the staff of the Cleveland Clinic in 1977 and was appointed Chairman of the Urology Department in 1985, which was later named the Glick- man Urological and Kidney Institute. Under Dr. Novick’s leadership, the Institute has grown from seven to 74 full-time faculty. The Institute also includes 40 residents and fellows, and seven basic research laboratories. It is currently the largest and most subspecialized urology program in the world. In the 1980’s, Novick pioneered nephron-sparing surgery (partial nephrectomy) for the treatment of kidney cancer. He also pioneered extracorporeal or “bench” kidney surgery for the repair of complex kidney disorders. To date, doctors at the Glickman Urological and Kidney Institute at Cleveland Clinic have performed more than 3,000 open partial nephrectomies, most of which were performed by Dr. Novick, giving the Institute the largest experience in the world. In addition to his surgical accomplishments, Dr. Novick discovered a correlation between chronic kidney disease and atherosclerotic renal artery disease. Dr. Novick also devoted significant effort to the understanding and management of end stage renal disease through renal transplantation, and to preserving renal function through reconstructive surgery.

20 Chimera Spring 2009 www.asts.org ASTS 10th Annual State of the Art Winter Symposium

The Cutting Edge Of Transplant Surgery Committed to Leading the Way in the 21st Century Pre-Meeting: Clinical Research in Transplantation Harbor Beach Marriott, Ft. Lauderdale, FL January 15 – 17, 2010 www.asts.org ATC-Journal-Ad-Bleed 9/3/08 11:49 AM Page 1 Mark Your Calendar! ASTS Events at ATC Friday, May 29, 2009 Council Meeting – Executive Session 11:00 – 11:30 AM: Council & Committee Chair Meeting ASTS Presidential Address Hynes Convention Center, General Session Room Saturday, May 30, 2009 12:15 – 12:30 PM: Council & Committee Chair Meeting ASTS Pioneer Award Presentation Council Meeting – Executive Session Hynes Convention Center, General Session Room Foundation Board of Directors Meeting 5:30 – 6:30 PM: Sunday, May 31, 2009 ASTS Business Meeting 8:30 – 10:30 AM: Hynes Convention Center, Room 313 Joint Plenary & ASTS Awards Ceremony Hynes Convention Center, General Session Room 6:30 – 6:45 PM: ASTS Award Presentations will begin at 9:15 AM Corporate Recogniton Ceremony Hynes Convention Center, Room 313 Tuesday, June 2, 2009 8:30 – 10:30 AM: 7:00 – 8:00 PM: Joint Plenary & ASTS Awards Ceremony ASTS Members Reception Hynes Convention Center, General Session Room Hynes Convention Center, Room 313 ASTS Award Presentations will begin at 9:15 AM

ASTS Announces WTC 2014 Ac a d e m i c Un i v e r s e What: National Transplant Surgery Fellowship Curriculum Who: ASTS members Where: ASTS Academic Universe – online at www.asts.org Why: To serve as the blueprint for educational growth and development

Objective The objective of the curriculum is to define the key areas of knowledge necessary for mastery of the field of transplantation surgery and to provide an educational guide for trainees as they progress through their fel- lowship and will serve as a dynamic reference for all ASTS members. Watch for updates online at www.asts.org! Coming Soon! TransplantationLiving Liver

videosASTS: Helping You Help Your Patients Creating Award Winning Educational Videos for the Transplant Community

Living Kidney Donation: What You Need to Know

Kidney Transplantation: A Guide for Patients and their Families Ask About Spanish Versions

www.asts.org Abdominal Transplant Surgery Fellowship Match Match Program The American Society of Transplant Surgeons (ASTS) is the sponsoring organization for the Abdominal Transplant Surgery Fellowship Match conducted via the National Resident Matching Program (NRMP). Visit www.asts.org and www.nrmp.org for detailed information concerning the Match.

Application Process The application process is independent from the Match and unique to individual institutions. Transplant Fellowship Programs use their individual application and interview process to evaluate potential transplant fellowship candidates for their programs. For a list of ASTS accredited Abdominal Fellowship Training Programs visit www.asts.org.

Registering for the Match Transplant Fellowship Programs and Applicants must register for the Match. More information about the Abdominal Transplant Surgery Fellowship Match & other programs focused on advancing surgical care in transplantation can be found on the ASTS website, www.asts.org. Schedule for Match Conducted in 2009, Appointment Year 2010 January 14, 2009 Match Registration Opens April 15, 2009 Rank Order List Entry Opens May 29, 2009 Program Quota Change June 10, 2009 Rank Order List Closes Certification June 24, 2009 Match Day

match ad for ajt 1208.indd 1 12/11/08 12:46:10 PM ASTS Business Practice Advisory What Every Transplant Surgeon Must Know

Kn o w Yo u r Wo r t h ! Ho w He a l t h y Is Yo u r Ke e p i n g Up Wi t h ASTS conducted a comprehensive Tr a n s p l a n t Pr o g r a m ? Na t i o n a l Tr e n d s ! compensation survey; now the Mock Medicare Services - ASTS The mission of the Business Practice most comprehensive report in the has assembled a team of transplant Advisory is to assist ASTS members in nation. The fifty-page report allows professionals and regulatory experts understanding the business aspect of individuals to evaluate their salary and who are standing by, ready to review transplantation and to help them keep benefits with their peers at the staff your program’s policies and procedures, up with national trends in transplant surgeon and program director level. evaluate compliance through on- practice management. The committee site chart review, conduct personal does this through seminars offered interviews and debriefing, and present during the ASTS annual Winter programs with a written report of Symposium. Coming Soon! Consultative Services, potential deficiencies. more to come. Job Board ASTS provides a Job Board as a benefit to its members. This is an abbreviated listing of the job postings currently available on the ASTS website. If you would like to submit a listing, please contact Chantay Parks Moye at [email protected] or 703.414.7870 ext. 101 for submission guidelines and fee requirements.

Ch i l d r e n ’s Ho s p i t a l Bo s t o n : Un i v e r s i t y Ho s p i t a l s , Salt Lake City, UT 84132 Administrati v e Pr o g r a m s Ca s e Me d i c a l Ce n t e r : Phone: 801-585-2816 Please contact: Su r g i c a l Di r e c t o r o f Li v e r E-mail: [email protected] Please refer to AutoReqID: 19017BR Tr a n s p l a n t a t i o n Website: www.childrenshospital.jobs Please contact: Un i v e r s i t y o f Vi r g i n i a James A. Schulak, MD De p a r t m e n t o f Su r g e r y : Ne w Yo r k Ci t y : Ki d n e y Chief, Division of Transplantation and Ab d o m i n a l Tr a n s p l a n t Tr a n s p l a n t Su r g e o n Se a r c h Hepatobiliary Surgery Su r g e o n Please contact: Director, UHCMC Transplant Institute Please contact: Lois Sacks 11100 Euclid Avenue Diana Houchens Director of Physician Recruitment Cleveland, Ohio 44106 Department of Surgery Yvonne Wallace, Senior Researcher Phone: 216-844-0307 E-mail: [email protected] Phone: 914-251-1000 x117 or x120 Fax: 216-844-5398 Fax: 914-251-1055 E-mail: [email protected] We s t c h e s t e r Me d i c a l Ce n t e r : Email: [email protected] Di r e c t o r , In t r a -Ab d o m i n a l [email protected] Un i v e r s i t y o f Co l o r a d o Tr a n s p l a n t Su r g e r y Website: www.ppasearch.com An s c h u t z Me d i c a l Ce n t e r : Please contact: Di r e c t o r o f Re s e a r c h Brian Joyce, Senior Associate So u t h e r n Il l i n o i s Un i v e r s i t y Please contact: www.jobsatcu.com/ Korn Ferry International Sc h o o l o f Me d i c i n e : applicants/Central?quickFind=57380. 695 East Main Street Tr a n s p l a n t Su r g e o n Benefits package: http://www.cu.edu/pbs/ Stamford, CT 06901 Please contact: Phone: 203-406-8799 Edward Alfrey, M.D., Un i v e r s i t y o f Ut a h : Fax: 203-327-2044 Department of Surgery Tr a n s p l a n t Su r g e o n E-mail: [email protected] P. O. Box 19638 Please contact: Website: http://www.wcmc.com Springfield, IL 62794-9638 John B. Sorensen, M.D. Provide names of three references. Chief, Section of Transplantation Email: [email protected] University of Utah Health Sciences Center Room 3B110 SOM

www.asts.org Chimera Spring 2009 27 Corporate Support The American Society of Transplant Surgeons would like to thank the following companies for their generous support of the ASTS in 2009

Benefactor Circle

Founder Circle

President Circle

Sponsor Circle

Associate Circle Foundation Contributors The American Society of Transplant Surgeons is grateful to the following individuals for their generous support of the Foundation of the ASTS and its mission. (New contributions since Winter 2009 in bold)

Distinguished Contributors

Marwan Abouljoud • Ronald Busuttil • Mehmet Haberal • Douglas Hanto • Mark Hardy • Goran Klintmalm • Shu Lin • Marc Lorber • Robert Merion • Anthony Monaco • Richard Pierson III • John Roberts • Jerry Rosenberg • James Schulak

Career Contributors

Nancy Ascher • Jonthan Bromberg • A. Benedict Cosimi • Francis Delmonico • Ronald Ferguson • Darla Granger • Mitchell Henry • Richard Howard • Dixon Kaufman • Stuart Knechtle • Jimmy Light • Joseph Leventhal • Arthur Matas • Richard Migliori • Charlie Miller • David Mulligan • Yoshifumi Naka • Scott Nyberg • Kim Olthoff • G. Alexander Patterson • Thomas Peters • C. Wright Pinson • Abraham Shaked • Richard Simmons • Vivian Tellis

Contributors

Peter Abt • George Abouna • James Allan • J. Wesley Alexander • James Allan • Angel Alsina • Hossein Shokouh-Amiri • Robert Andersen • Christopher Anderson • Massimo Asolati • Clyde Barker • James Bowman III • Pedro Baron • Cristoph Broelsch • Jonathan Bromberg • Gordon Burtch • Andrew Cameron • Vincent Casingal • Mark Cattral • David Conti • Spencer Day • Juan Del Rio Martin • Alp Demirag • Niraj Desai • James Eason • Devin Eckhoff • Carlos O. Esquivel • Lon Eskind • Casimir Firlit • David Follette • O.H. Frazier • Richard Freeman • Amy Friedman • John Fung • Ahmed Gaber • Pierre Gianello • Jeremy Goodman • Hans Albin Gritsch • Scott Grubber • Arturo Hernandez • Mark Hill • Garrett Hisatake • Lynt Johnson • Sang-Mo Kang • Sandip Kapur • Philip Karuman • Burnett Kelly • Dympna Kelly • William Kendall • Nabil Khamid • Dong Sik Kim • Masaaki Kimikawa • Richard Knight • Babuaro Koneru • Tomasz Kozlowski • Max Langham • Hyung Lee • Joseph Lee • Robert Madden • Joren Madsen • George Mazariegos • Robert McCabe • Jason McMann • Robert McMillan • Robert Mendez • Bhargav Mistry • Elijah Mobley • Ponnusamy Mohan • Paul Morrisey • Robert Montgomery • Martin Mozes • Susan Orloff • Wael Otaibi • Anil Paramesh • Guillermo Solorzano Peck • Thavam Chenthan Thambi-Pillai • Elizabeth Pomfret • James Pomposelli • Kadiyala Ravindra • Alan Reed • David Reich • Gonzalo Rodriguez-Laiz • Richard Ruiz • Paul Russell • Bob Saggi • Benjamin Samstein • Juan Sanabria • Eduardo Santiago • Randolph Schaffer III • Ashish Shah • Mark Slaughter • Roberto C. Lopez-Solis • Christopher Sonnenday • Nancy Stegens • Randall Sung • Miguel Tan • Lewis Teperman • Nicholas Tilney • Georgios Tsoulfas • Jeffrey Veale • Kenneth Woodside • Yohichi Yasunami • Serdar Yilmaz • Krzystof Zieniewicz

Log on to www.asts.org/Society-Foundation to learn about the Foundation of theASTS, its projects and to make a contribution. www.asts.org Chimera Spring 2009 29 Calendar The ASTS is pleased to coordinate with other professional organizations in order to maintain a relevant events calendar. If your organization would like to list an event, please contact Chantay Parks Moye at 703.414.7870 ext. 101 or [email protected].

April 2009 August 2009 March-May 2009 August 2-5, 2009 Pl a n Ah e a d Live Regional Meeting Series NATCO’s 34th Annual Meeting How Do We Prolong Graft Function River Rock Hotel and Improve Cardiovascular Las Vegas, NVPhone: 913-895-4612 Event-Free Survival in the Kidney Email: [email protected] Transplant Recipient? Website: www.natco1.org See website for location, date, and times www.sceptercme.com/kidneytransplant August 30-September 2, 2009 TH 14 Congress of the European Society ASTS 10th Annual State of April 18-21, 2009 for Organ Transplantation (ESOT) 5th Congress of the International Pediatric Paris, France the Art Winter Symposium Transplant Association (IPTA) Website: www.esot.org January 15-17, 2010 Istanbul, Turkey Askeri Museum September 2009 Marriott Harbor Beach, Email: http://www.iptaonline. September 11-12, 2009 Fort Lauderdale, FL org/5thcongress 9th Meeting of the International Society of Hand and Composite May 2009 Tissue Allotransplantation March-May 2009 Valencia, Spain Live Regional Meeting Series Director: Dr. Pedro Cavadas How Do We Prolong Graft Function and Website: www.ctavalencia2009.com Stay current with Improve Cardiovascular E-mail: [email protected] Event-Free Survival in the Kidney Trans- ASTS by visiting plant Recipient? September 23-26, 2009 See website for location, date, and times Transplant Immunosuppression: the ASTS website www.sceptercme.com/kidneytransplant Today’s Issues Radisson University Hotel at www.asts.org. May 20, 2009 Minneapolis, MN ASTS 3rd Annual Transplant Fellowship http://www.cmecourses.umn.edu Training Meeting Chicago, O’Hare Hilton February 2010 Chicago, IL February 4-7, 2010 9th International Conference May 30-June 3, 2009 on New Trends in Immunosuppression American Transplant Congress and Immunotherapy Boston, MA Kenes International Prague June 2009 Website: www.kenes.com There you can learn June 19-23, 2009 Introductory Education Course for the May 2010 more about who we New Transplant & Procurement May 1-May 5, 2010 are, what we do, why Professional American Transplant Congress Tempe Mission Palms Hotel San Diego, CA we care, and how you and Conference Center Tempe, AZ can get involved. Phone: 913-895-4612 Email: [email protected] Website: www.natco1.org

30 Chimera Spring 2009 www.asts.org New Members For more information on becoming a member, please go to www.asts.org or contact the ASTS National Office at (703) 414.7870 or [email protected]

Sophoclis P. Alexopoulos, MD Tamer A. Malik, MD Stanford University Medical Center University of Nebraska Medical Center NATCO, Diane Alonso, MD Manoj K. Maloo, MBBS, MD Intermountain Hospital Welcome to the Geisinger Medical Center

Angel Joaquin M. Amante, MD American Society Amit K. Mathur, MD National Kidney & Transplant Institute of Transplant University of Michigan

Ronald C. Auvenshine, DO Surgeons! Shiva C. Muthukumaraswamy, UCLA Transplant Center - Dumont BHD, MBChB Surgeons work side by side with Mayo Clinic Srinivas P. Chava, MBBS, FRCS clinical coordinators, Nurse Prac- University of California San Diego Saravanan Ramalingam, MD titioners, Physician Assistants and University of Rochester Alejandra Cicero, MD procurement coordinators during University of Texas the recovery process. It makes a Rafael Reyes-Acevedo, MD great alliance to share resources Centenario Hospital Miguel Chirag S. Desai, MD, MS and develop programs of mutual Georgetown University Hospital Andrew L. Singer, MD, PhD interest. As an ASTS member, The Johns Hopkins Hospital Debbie A. DiMartino, PA-C you will have access to many Rush University Medical Center member benefits such as: Arun K. Singhal, MD, PhD University of Utah Tayyab S. Diwan, MD • American Journal of Mayo Clinic Transplantation (AJT) Daniel S. Warren, PhD Johhs Hopkins University School • Member’s section of the Derek A. DuBay, MD of Medicine University of Alabama Birmingham ASTS website • The Chimera, Alvin C. Wee, MD Amy R. Evenson, MD the ASTS Newsletter Cleveland Clinic Foundation Northwestern Memorial Hospital • Online membership directory • ASTS Academic Universe Emily R. Winslow, MD Felix E. Geissler, MD, PhD Northwestern Memorial Hospital (online curriculum) Bristol-Myers Squibb Patient Education Tools Piotr P. Witkowski, MD, PhD Vinod Gollapalli, MD, MRCS Advocacy Program Columbia University University of Miami – Jackson Memorial ... and much more Hospital Govardhana R. Yannam, MBBS, MD University of Nebraska Medical Center Jonathan C. Hundley, MD Henry Ford Hospital Tun Jie, MD, MS University of Minnesota Hirohito Ichii, MD, PhD Miami Transplant Institute John C. LaMattina, MD University of Wisconsin Hospital & Clinics

It’s Truly A Great Time To Be A Member www.asts.org Chimera Spring 2009 31 ASTS Na t i o n a l Of f i c e 2461 So u t h Cl a r k St r e e t Su i t e 640 Ar l i n g t o n , VA 22202

How healthy is your Mock Medicare Survey transplant program? Are you ready for the CMS audit? (MMS) Would you like to hand CMS your (MMS) corrective action plan the day they arrive? Reduce stress, reduce program disruption and sail through your Medicare Audit.

ASTS has assembled a team of seasoned transplant professionals and regulatory experts who are standing by to review program policies and procedures, evaluate compliance through on-site chart review, conduct personnel interviews and debriefings and present programs with a written report of potential deficiencies.

Contact ASTS for testimonials or to schedule your MMS today!

703.414.7870 www.asts.org [email protected]