Published for Members of the American Society of Transplant Surgeons

Vol. XVIII, No. 2 Winter 2008

President’s Letter 4 Members Business Meeting 5 Member News 6 Regulatory & Reimbursement 8 Legislative Report 10 OPTN/UNOS Corner 12 HRSA Collaboratives 13 Surgical Fellows Symposium 14 National Living Donor Assistance Center 16 8th Annual State of the Art Winter Symposium 19 Shop ASTS 23 Corporate Support 26 Foundation 27 Job Board 28 New Members 30 Calendar 31

www.asts.org ASTS Council May 2007–May 2008

President Treasurer Richard B. Freeman, Jr., MD (2010) Goran B. Klintmalm, MD, PhD, FACS Michael M. Abecassis, MD, MBA Tufts University School of Medicine (2008) (2009) New England Medical Center Baylor Regional Transplant Institute Northwestern University Department of Surgery 3500 Gaston Avenue Division of Transplantation 750 Washington St. Box 40 Dallas, TX 75246 675 North St. Clair Street, #17-200 Boston, MA 02111 Phone: 214 820.2050 Chicago, IL 60611 Phone: 617 636.5592 Fax: 214 820.4527 Phone: 312 695.0359 Fax: 617 636.8228 Email: [email protected] Fax: 312 695.9194 Email: [email protected] Email: [email protected] President-Elect Dixon B. Kaufman, MD, PhD (2010) John P. Roberts, MD (2008) Councilors-at-Large Northwestern University University of California San Francisco Mitchell L. Henry, MD (2008) Division of Transplantation Division of Transplantation The Ohio State University 675 North St. Clair Street, #17-200 505 Parnassus Avenue Department of Transplantation Chicago, IL 60611 Box 0780, Room M896 1654 Upham Drive, #345 Means Hall Phone: 312 695.0257 San Francisco, CA 94143-0780 Columbus, OH 43210-1250 Fax: 312 695.9194 Phone: 415 353.1888 Phone: 614 293.4627 Email: [email protected] Fax: 415 353.8709 Fax: 614 293.4541 Email: [email protected] Email: [email protected] National Office Katrina Crist, MBA Immediate Past President Kim M. Olthoff, MD (2008) Executive Director Arthur J. Matas, MD (2008) University of Pennsylvania Hospital 2461 South Clark Street, Suite 640 University of Minnesota Department of Surgery Arlington, VA 22202 Department of Surgery, Box 328 UMHC 3400 Spruce Street, 2 Dulles Phone: 703 414.7870 420 Delaware Street, SE Philadelphia, PA 19104 Fax: 703 414.7874 Minneapolis, MN 55455 Phone: 215 662.6136 Email: [email protected] Phone: 612 625.6460 Fax: 215 662.2244 Fax: 612 624.7168 Email: [email protected] Email: [email protected] Robert L. Kormos, MD (2009) Past President University of Pittsburgh Medical Center A. Benedict Cosimi, MD (2008) Department of Surgery C700 Massachusetts General Hospital 200 Lothrop Street Department of Surgery Pittsburgh, PA 15213 55 Fruit Street Phone: 412 648.8107 Boston, MA 02114 Fax: 412 648.1029 Phone: 617 726.8256 Email: [email protected] Fax: 617 726.8137 Email: [email protected] Alan N. Langnas, DO (2009) University of Nebraska Medical Center Secretary PO Box 983280 Robert M. Merion, MD (2008) 600 South 42nd Street Please Note… University of Michigan Omaha, NE 68198-3280 315 West Huron, Suite 240 Phone: 402 559.8390 A full listing of ASTS Ann Arbor, MI 48103-4262 Fax: 402 559.6132 Committees and their Phone: 734 936.7336 Email: [email protected] members can be found on the Fax: 734 998.6620 ASTS website, www.asts.org, Email: [email protected] under the Society tab.

 Chimera Winter 2008 www.asts.org Editor’s Letter

CPublishedhfor Membersiof mthe American Societyeof Trransplant Surgeonsa Published for Members of the American Society of Transplant Surgeons Published for Members of the American Society of Transplant Surgeons

Vol. XVIII, No. 2 Winter 2008 President’s Letter 4 Members Business Meeting 5 Vol. XVII, No. 3 Spring 2007 Vol. XVIII, No. 1 Summer 2007 Member News 6 President’s Letter 4 Regulatory & President’s Letter 4 Reimbursement 8 New Members 5 Regulatory & Legislative Report 10 Legislative Report 6 Reimbursement 6 OPTN/UNOS Corner 12 Regulatory & Legislative Report 8 HRSA Collaboratives 13 Reimbursement 9 ASTS News 10 Surgical Fellows ASTS News 12 American Transplant Symposium 14 Congress (ATC) 12 Living Donor Video 14 National Living Donor Research Awards 17 Assistance Center 16 American Transplant Call for Abstracts 19 8th Annual State of the Congress (ATC) 15 Art Winter In Memoriam 20 7th Annual State of the Art Symposium 19 Organ Retrieval 21 Winter Symposium 16 Shop ASTS 23 Fellowship Program Corporate Support 26 Foundation 22 Directors Meeting 23 Foundation 27 Corporate Support 23 Corporate Support 24 Job Board 28 Calendar 23 Calendar 25 New Members 30 Job Board 28 Foundation 26 Calendar 31 Match Information 30 New Members 29 Call for Abstracts 31

www.asts.org www.asts.org www.asts.org

he Chimera reflects the prin- that they are highly skilled and trained We want to hear from you. Please ciples and values of the Society. surgeons. A full article of events can be forward all comments to the ASTS TThe ASTS is committed to add- found on page 14. National Office at [email protected]. ing value to its membership by staying committed to ASTS initiatives that will In a first of its kind collaboration with Best regards, help increase organ donation, provide the US Government, the ASTS and a better quality of life for transplant the University of Michigan launched James Whiting, MD patients and advance the practice and the National Living Donor Assistance Chair, Communications Committee science. This year the ASTS has made Center (NLDAC). The primary purpose numerous contributions to the field of of the NLDAC is to lessen the burden of Chantay Parks transplantation. travel and subsistence expenses toward Managing Editor living organ donation. The Division [email protected] As ASTS approaches its 8th Annual of Transplantation, Health Resources State of the Art Winter Symposium, it and Services Administration (HSRA) Karol A. Keane was essential to the Society to broaden anticipates providing eight (8) million Design & Communications, Inc. the learning opportunities. Under dollars over four years to provide reim- [email protected] the direction of the Ad Hoc Business bursement to eligible donors. Practice Committee, the Society is host- About the cover… ing its first Business Practice Seminar Who is eligible for reimbursement from entitled Medicare 101: What Every the NLDAC? What qualifying expenses The cover photo is of a live-donor Transplant Surgeon Must Know. The mis- are covered by the NLDAC? What is renal allograft with urine output sion and/or basis for the seminar are to the maximum federal reimbursement for after reperfusion. Stay sutures sur- assist ASTS members in understanding qualified expenses during the donation round the bladder mucosa exposed the business aspect of transplantation process? Answers to these and other for the ureteral anatomosis. The and to follow national trends in trans- questions can be found at ASTS is grateful to Rod Mateo, plant practice management. www.livingdonorassistance.org. MD, FACS for submitting the photograph. Dr. Mateo is with Another ASTS first; over 50 trans- As a member, you are in a strong posi- the USC Department of Surgery, plant fellows met in Maui, Hawaii for tion to improve transplantation science Keck- University of Southern the ASTS Inaugural Surgical Fellows and medicine, not only by the work that California School of Medicine. Symposium, November 7-11, 2007. you do, but also by supporting ASTS The Fellows Symposium is designed to sponsored initiatives; make a contribu- If you have a photo that you address frequently cited gaps in fellow- tion to the Foundation of the ASTS. would like displayed on the cover ship training and provide a platform for Donating is easy, through the “renew of the Chimera, please e-mail it to unparalleled interaction with peers and my membership” function on the ASTS Chantay Parks, faculty experts. In addition, the sympo- website or by sending a check payable to [email protected]. sium will help define a curriculum that the ASTS Foundation. sets standards for fellows and ensures www.asts.org Chimera Winter 2008  President’s Letter

t is an honor to serve as your years ago, as well as the discovery of ques- President. I am equally grateful to be tionable transplant practices with a few Iable to devote considerable atten- programs in California. The response tion to Society initiatives that benefit from OPTN/UNOS, CMS, JCAHO you and your patients. In the past year, and Congress has been strong, if not to the ASTS council and committees have say overwhelming. Well-intentioned more rigorously championed a plethora individuals have forwarded an abundance of federal agencies (OPTN/UNOS, of new rules and proposed regulations. CMS, JCAHO, HRSA - the alphabet Quite frankly many of these rules are so seems endless), on issues that could have prescriptive in that they are legislating profound affects on transplantation. the practice of medicine. Some are so intrusive and heavy handed that they The change in our bylaws last May that will make transplantation difficult to per- removed the requirement for publica- form and may have a profoundly negative tion in the field of transplantation in impact on organ donation rates if imple- order to become an ASTS member has mented. The administrative cost aspect been well received. By the first week of alone is a major issue with the possibility August we had received as many new that all transplant programs will have to membership applications as we did in Goran B. Klintmalm, MD, PhD, FACS add staff simply to process the paperwork. the twelve months prior to the change. ASTS President However, it is not only the regulations To engage all practicing transplant and the bylaws themselves that are con- surgeons, regardless of specialty, not a seminar at the 8th Annual State of cerning, but also the guidelines and how only makes us stronger, but better suited the Art Winter Symposium in Marco the regulations should be implemented. to deal with various facets of future Island, Florida, January 25 - 27, 2008. There is an apparent risk that transplant developments. We must ensure that the The title of the seminar is Medicare 101: centers will have to follow three separate Society is relevant to all members. What Every Transplant Surgeon Must and diverging set of rules and guidelines Know. In contrast to any of the previous with separate reviews and approval Increasing the value of the membership, presentations you may have attended on processes for each. Potentially, a center ASTS has instituted an Ad Hoc Business the subject, this will not be focused on could be found in compliance with two Practice Advisory Committee. Dr. Medicare legal language and the institu- of the governing agencies, but out of Marwan Abouljoud is the chair and he tional impact and ramifications, but will compliance with the third. is joined by Drs. Glenn Halff, Paul Kuo show you what you must know for your and Alan Langnas. Dr. Mike Abecassis own protection, as well as how to be able The Society has worked vigorously for a serves in an advisory role. Rebecca Burke to effectively bill and collect for your year and a half with CMS in order to be and Diane Millman, lawyers at PPSV in services. There will be seven presenta- proactive and has had excellent results. Washington, DC, advise on the commit- tions, each followed by a significant time The agency has been very responsive and tee as well. The Committee is currently for Q & A. Only ASTS members can the final rule was made far less ominous developing a strategy and road map on register and participate in the seminar. and more relevant. We are now working what subjects to address and in which or- The Society will make sure that we keep with them to develop clinically valid and der, organization, reporting relationships, you informed on the continuing develop- realistic guidelines for implementation of staffing, billing-collection, recruitment, ment of this committee. the final rule. income, retirement, and succession plan- ning to mention a few possibilities. The Another important issue confronting Similarly, the Society has taken a very number of concerns is seemingly infinite. transplantation is an unprecedented de- active role working with OPTN/UNOS velopment of new regulations. The rea- in making recent bylaws proposals real- Understandably, it will take time before son for this is clearly multi-factorial. It is istic. This is particularly true in the field comprehensive advice and information partly due to a trend in our country cou- of living donor organ donations where will be available, but in an effort to begin pled with events particular to transplan- policies are under development, but prog- to impart valuable information to the tation, such as the much reported death ress has been made. membership, the committee will host of an organ donor in New York several

 Chimera Winter 2008 www.asts.org After many months of refusal to engage are available. Program directors can projected job market and determine how in meaningful communications with our monitor their fellows’ progress and the many surgeons we need to train. Society, JCAHO seems to have finally Society will have documentation that realized that they cannot write a set of the fellows have indeed received the Organ transplantation can almost be used rules and guidelines and then implement core instructions. The fellows will also as the definition for multi-specialty team them if the Society declares the JCAHO keep their case logs on the ASTS website care and treatment and for the most part position clinically irrelevant. Recently enabling the Society to make sure that is led by transplant surgeons. With this we have been able to commence a dialog the expected case volumes are met. This leadership comes a huge responsibility, not that hopefully will result in meaningful will ensure that the case volumes are not only for ourselves as professionals, but for JCAHO program certifications. This is only being met by the fellows, but also by our colleagues, our institution, society at unquestionably a work in progress. the training program for the continued large, and most of all to our patients. accreditation as a fellowship program. The Society is also rapidly advanc- Who would be a better and more in- ing its work on the development of Parallel to the curriculum for the fel- formed living donor advocate than we? a curriculum for transplant surgery lows, we are initializing a curriculum for We must help agencies and organizations fellows. We are in the advanced stages surgical residents who rotate through our do what is right for our patients. Having of discussions over the acquisition of a programs. It is incredibly important that good intentions without knowledge is web-based program that will provide the residents get a meaningful experience not enough and can be detrimental. The fellows with study modules. It will also while in contact with transplantation. ASTS is committed to spending our time provide the program directors and the The future of the specialty demands and resources to provide the knowledge Society with verification of the fellows’ that we can attract and engage bright that is needed. progress. Several ASTS committees are young surgeons. However, to attract working on the development of differ- these bright young surgeons we have to ent aspects of the online curriculum in ensure that the future provides a strong order to make components accessible at job market for ASTS fellowship trained any time. This will allow the fellows to transplant surgeons. We are currently Goran B. Klintmalm, MD, PhD, FACS work on modules during the times they working to evaluate the current and ASTS President Call to Order ASTS Business Meeting January 26, 2008 8th Annual State of the Art Winter Symposium Marco Island, Florida

Why: To consider an increase in the number of coun- When: 12:30 pm, Saturday, January 26, 2008 cilors-at-large from six (6) to nine (9). The proposed increase would provide a larger pool of candidates Where: Marco Island Marriott, during the ASTS 8th from which to select officers and a president-elect and Annual State of the Art Winter Symposium; Salon represent the recent growth of the Society. A-D, lobby level; Following the adjournment of the session. A boxed lunch will be served. The ASTS membership is growing and the Society’s programs and initiatives continue to expand. In the NOTE: Participation in the Winter Symposium last year, individuals applying for ASTS member- is not a prerequisite of attending the Business ship have increased by 40%. As you know, the ASTS Meeting. recently changed its bylaws to eliminate the publica- tion requirement as criteria for ASTS membership. There is still time to register for the 8th Annual State Since then, the ASTS has received an even greater of the Art Winter Symposium January 25-27, 2008. interest in its membership. Expanding the number The Pre-meeting Course, Practical Knowledge for of councilors will allow for greater representation on Transplant Surgeons, is January 24-25, 2008. the Council and more opportunities for members to Pre-registration expires January 10, 2008. Visit the participate in leadership positions. ASTS website for details. This is a CME event.

www.asts.org Chimera Winter 2008  ASTS News The ASTS Fall Council and Committee Chair Meeting was held in Chicago, IL, September 19, 2007. The following are key committee news and reports from the meeting. Please visit the ASTS website for current and recent committee activities.

ATC Program Planning legal counsel to address the reimburse- publication of a transplant critical care Committee ment of pancreata procured for islets and manual including donor management. Dr. Mark Stegall reported that plan- intent to transplant for pancreas issues ning is underway for 2008 and that the with CMS. Curriculum Committee Program Committee is incorporating Dr. Elizabeth Pomfret presented the feedback from 2007 to improve the CME Committee completed unit and learner objectives program. The council agreed that a 72% Dr. Milan Kinkhabwala reported that for the curriculum, which will be posted acceptance rate was too high and agreed the Committee is seeking approval to on the ASTS website following Council that the acceptance rate for 2008 be move forward with a pilot Maintenance and committee chair comments. The reduced to increase quality. of Certification (MOC) program in col- proposed resident curriculum based on laboration with the ABS. The goal of immunosuppression, organ procurement, Awards Committee the program would be to develop a novel kidney transplant and liver transplant Dr. Abhinav Humar reported that program for ASTS members to maintain was also presented. Lastly, Dr. Pomfret the first ASTS-Astellas David Hume their ABS MOC requirements using presented information concerning the Bridge Award has been awarded to Dr. content that is specific to transplanta- Thoracic Surgeons Directors Association Gerald S. Lipshutz from the University tion. The pilot program would focus on (TSDA) Curriculum project and its ap- of California Los Angeles. Dr. Humar “Lifelong Learning and Self-Assessment.” plication to an ASTS online curriculum presented information on the new Dr. Kinkhabwala also presented proposed and demonstrated the platform and its medical student award which replaces the standards for outside requests for ASTS various components including the learn- Presidential Travel Award. There will be sponsorship of CME activities. ing modules, operative logs and podcasts. four awards per year. The Committee has finalized details for the ASTS-ACS NIH Communications Committee Ethics Committee Supplement Award that will be available Dr. James Whiting reported that there Ms. Katrina Crist reported on behalf of to ASTS members, $75,000 /year, who continues to be a positive response to Dr. Charles Miller that planning is well receive an NIH K08 or K23 award. the new layout of the Chimera and the underway for the three way collabora- Committee plans to add more “Society” tive conference with the Academy of Bylaws Committee related content. He reported that the Psychosomatic Medicine (APM) and the Dr. Stuart Flechner reported that the website is also being updated multiple Chicago Transplant Ethics Consortium Council voted to move forward with times a week; surgical videos have been (CTEC). The conference will be held an initiative to increase the number of added to the members’ portal; naviga- April 4-6, 2008 and is titled: Dilemmas councilors-at-large from six to nine to tional features have been improved and and Struggles in Transplantation: Ethics, involve more members of the Society in monthly web trend reports show an Psychosocial Considerations and Policy. the leadership and provide a larger pool increase in visits to the website since last of candidates from which to select officers year. The Committee is working on the Fellowship Training Committee and a president-elect. The Society will development of a Spanish version living Dr. John Magee reported that a sub- host a members’ business meeting at the kidney donor video, a recipient video and committee has been appointed to study 2008 Winter Symposium to consider a an improved Foundation section. the current accreditation standards and bylaws change. A proposal was discussed make recommendations for improv- to explore alternative options for the Critical Care Initiative ing the current system. Dr. Magee also membership to vote on Society issues. Dr. Dinesh Ranjan presented information presented the Managed Time Policy. The from the ASTS Critical Care Survey. Committee recommended mandating Cell Transplant Committee Of the members that responded, 90% that all programs adopt the proposed Dr. James Markmann presented the re- reported providing critical care and 95% policy or submit an alternative policy as vised white paper on islet cell transplant supported a critical care initiative led by requirement of ASTS accreditation. The and procurement charges for pancreata the ASTS. The Committee approved Council endorsed the development and used for islets. The OPTN/UNOS has the creation of a task force to collabo- implementation of a standardized fel- requested to be the sole author. The rate with the Society of Critical Care lowship application process. This would Committee is still dealing with the Intent Medicine (SCCM). The task force will help the ASTS track fellows in train- to Transplant issues, especially for pan- identify specific topics for specific organs ing. In addition, the Council endorsed creas. Dr. Abecassis suggested engaging that merit further education, consider making it a requirement that all fellows

 Chimera Winter 2008 www.asts.org become candidate members of the ASTS obtaining new ICD-9 codes in order to a registry. He added that Dr. Feng drafted and that associated costs (AJT online track donor organs quality and to classify a concept sheet on clinical trial design subscription) be offset by the annual ac- the type of donor organ used in each pro- issues as requested by Council to send creditation fee effective January 1, 2008. cedure. The establishment of these new to FDA. The Committee designed and All accredited programs will now report codes would take several years. See full distributed the ASTS DonorNet Survey their fellows on an annual basis to allow Reimbursement Report on page 8. in order to gather feedback on its impact ASTS to monitor fellows who switch on individual programs. training programs during their fellow- Regulatory Report ship and fellows who did not match, but Dr. Michael Abecassis reported that Vanguard Committee subsequently were accepted to training the ASTS was anxiously awaiting the Dr. Randall Sung reported that planning programs. interpretive guidelines for the CMS rule. is underway for the 8th Annual Winter It was explained that the initial surveyors Symposium on The High Risk Recipient Legislative Committee are relatively uninformed and recom- which will be held again in Marco Island. Dr. Richard Freeman reported that the mended that transplant centers challenge A pre-symposium course on Practical Living Kidney Paired Donation Bill the surveyors on issues of concern until Knowledge for the Transplant Surgeon stalled in Congress due to a change in the interpretive guidelines are available. will be offered and Dr. Abouljoud language by the Senate but presumably The Council discussed the JCAHO will lead the Career Development will eventually pass despite the tem- certificate of distinction/transplant cer- Symposium, Burnout and Work/Life porary set back. Dr. Freeman reported tification program the Joint Commission Balance. See 2008 Symposium preview that there are continued efforts to fund is launching in lieu of being able to seek on page 19. The Council approved the the Organ Donation Act (ODA) and deemed status for renal. The consensus restructure of the Vanguard Prize to interest in providing funding to link state was that ASTS should advise members reduce the awards from four to two per registries. There is also renewed effort in that the JCAHO certificate is voluntary. year, allowing for nominations from the House for a comprehensive Medicare The OPTN/UNOS Board accepted the authors, program directors and Vanguard package that would include extended ASTS recommendations in the OPTN/ Committee members, and increase the immunosuppressive drug coverage for UNOS proposed living donation guide- prize amount. Lastly, he reported that ESRD patients beyond three years. See lines (bylaws) that passed. The current the new Francis Moore Excellence in the full Legislative Report on page 10. version of the medical and psychosocial Field of Transplantation Surgery Award evaluation resource document is being will be awarded to the first two recipients Membership Committee revised; ASTS has submitted its position. at the Winter Symposium. Dr. Timothy Pruett reported that targeted See full Regulatory Report on page 8. letters have been sent to non-member Ad Hoc Business Practice cardiothoracic and abdominal transplant Standards Committee Committee surgeons, encouraging them to take Dr. David Mulligan presented the recom- Dr. Marwan Abouljoud presented the advantage of the value and benefits of mended standards for organ procurement. draft program for the workshop that will becoming an ASTS member. The mem- Ultimately, there was support to include be held prior to the Winter Symposium bership voted in May to eliminate the a US Medical license requirement due to titled Medicare 101: What Every publication requirement as criteria for legal concerns and the ability to detect Transplant Surgeon Must Know. See ASTS membership. It was reported that disease during the procurement. The overview of workshop on page 19. Dr. the membership booth received a great Committee will add a grandfather clause Paul Kuo is working on the development deal of traffic during ATC distributing and revise the recommendations. Dr. of a practice model survey that would over 500 membership packets. Another David Reich has drafted DCD trans- be addressed to division/center chiefs to membership campaign is underway with plant guidelines that are designed to be explore reporting relationships, financial the possibility of creating a standing non-prescriptive. The Committee will staffing, levels of autonomy, subsidy and committee to represent surgical associates also review the existing measures for taxation models, overhead allocation, and to study the possibility of a curricu- Physician Quality Reporting Initiative redundancy in staffing to provide cover- lum aimed at physician extenders. (PQRI) in liver and kidney transplanta- age, and etc. tion and recommend additional measures Reimbursement Committee specific to transplant to support quality Ad Hoc Living Donor Committee Dr. Michael Abecassis reported that metrics unique to transplantation. Dr. Andrew Klein reported that the CMS recently published its final FY Committee is developing safety and 2008 inpatient prospective payment Scientific Studies Committee risk statements for living donors. The system (IPPS) rule which included new Dr. David Gerber provided a summary Committee is striving for greater collabo- severity-based DRGs for heart and liver on the recent Combined Kidney/Liver ration with the OPTN/UNOS Living transplants. Due to inadequacies apply- Transplantation Consensus Conference Donor Committee to develop guidelines. ing the two tired system to transplants, in Chicago. A paper will be submitted CMS recommended that ASTS consider for publication and they hope to organize www.asts.org Chimera Winter 2008 7 Regulatory & Reimbursement Update

New DRGs for Liver and Heart forth below.) CMS increased the DRG Transplants weights for the uncomplicated cases, Effective October 1, 2007 Medicare substantially reducing the payment implemented a new system of hospital differential between “with MCC” and DRGs based on severity of illness. The “without MCC” admissions. new system affects both liver and heart transplants. Under the previous DRG Note that Intestinal and Multivisceral system, there was only one DRG for transplants will all be assigned to the heart transplants and one for liver trans- higher-severity liver DRG. CMS again plants. Under the new system there are declined to create a separate DRG for two DRGs each for both liver and heart combined liver/kidney transplants. transplants, depending upon whether However, CMS expects that all liver/ or not the patient has a “major compli- kidney combined transplants will be cating condition” (MCC). The DRG assigned to the higher paying liver trans- weight, and consequently Medicare pay- plant DRG if they are properly coded. ment, is higher for patients with a MCC in payments between the complicated than without a MCC. ASTS met with and uncomplicated cases, as articulated Severity-based DRGs were not created Medicare staff to express its opposition in the proposed rule, would result in for any other solid organ transplants, to the creation of severity based DRGs substantial underpayments to hospitals. and kidney, pancreas, combined kid- for these procedures. ASTS took the While CMS disagreed with ASTS’ posi- ney/pancreas, and lung transplants each position that there are no truly “uncom- tion and finalized severity-based DRGs are associated with a single DRG. The plicated,” heart or liver transplants and, for these procedures; ASTS did effect Table on page 9 compares the 2007 and further, that the significant disparity change in the final payment rates (set 2008 DRG weights for these procedures. With the exception of pancreas/kidney the reductions are all less than in the 2007 DRG 2007 DRG Proposed 2008 Final 2008 Percent proposed rule. Weight and MS- DRG DRG Weight Change Payment and payment between Hospital Update Factors amount* amount* 2007 and and Reduction of 2008 “Behavioral Offset” The update factor for hospitals in FY Heart Tx or 18.8653 Heart Tx or 23.1117 +22% 2008 is 3.3%. The final CMS rule had implant of heart $93,606 implant of heart $114,680 included an offsetting 1.6% across the assist system assist system w/ board reduction in DRG payments to MCC compensate for what CMS believed would be an overall increase in pay- Heart Tx or 16.2735 -13% ments due to more precise coding under implant w/o $80,749 the new severity-based DRGs. This MCC provision was vigorously opposed by the hospital community and, in September Liver Tx 9.4096 Liver Tx w/ 10.6120 +12% of this year, Congress passed legislation (includes $46,690 MCC or $52,656 which reduced the cut to 0.8%. intestinal Tx) intestinal Tx Implementation of Medicare Liver Tx w/o 7.2562 -23% Certification Program for MCC $36,005 Transplant Centers The new transplant center regulations * Payment amount is based on the FY 2008 national standardized amount ($4962), assumes a wage index became effective on June 28, 2007, and of 1, and does not include organ acquisition costs, geographic adjustments, capital adjustments or other transplant centers that are currently cer- sources of reimbursement such as GME payments to teaching hospitals. tified by Medicare have until December

 Chimera Winter 2008 www.asts.org 26, 2007 to submit applications for ap- proval to CMS. New centers can apply DRG 2007 Weight Final 2008 Weight Percentage change at any time. Lung 8.4182 8.4002 -1% Centers that have already submit- ted their applications are undergoing Pancreas/Kidney 6.2588 5.1726 -17.3% unannounced surveys by Medicare. In conducting these surveys, surveyors Pancreas 3.9771 3.8902 -2% currently are applying draft Interpretive Guidelines that purport to interpret the Kidney 3.1152 3.0654 - 1.5% certification regulations. ASTS has re- viewed the draft Interpretive Guidelines and has a number of serious concerns, Joint Commission Transplant guidelines which would impose a num- which have been communicated both Center Certification Program ber of new requirements on transplant to CMS and to staff of Senator Grassley, The Joint Commission is proceeding centers and surgeons with respect to the chair of the Senate Finance with its transplant certification program. living donors. ASTS submitted compre- Committee, which has jurisdiction over Draft standards were circulated to the hensive comments on the draft changes the Medicare program. field, and ASTS submitted written com- and is working with the OPTN to revise ments. ASTS also met with the Joint its guidelines in this area. Generally, the Interpretive Guidelines Commission to discuss its many con- appear to go well beyond what is re- cerns, including those related to: Medicare 2008 quired by the underlying regulations and Physician Fee Schedule impose requirements that are extremely • The authority of the Transplant The 2008 Medicare physician fee sched- prescriptive and detailed. In addition, Surgeon to direct transplant pro- ule is expected to be published in early the Guidelines reflect a lack of under- grams November. The relative value units standing of how transplant centers oper- • Qualifications of living donor advo- assigned to transplant procedures is not ate. Some of the areas we expect will be cate expected to change significantly from particularly problematic include: • Informed consent requirements prior years, and, to the extent that there • Waitlist management are changes, they are generally the result • Interpretation of outcomes and • Verification of recipient and donor of overall budget neutrality adjustments volume data blood types imposed on all services. For example, all • Qualifications and role of living • Individualized plans of care physician work RVUs are subject to a re- donor advocate • QAPI requirements duction of approximately 10 percent in • Responsibility of transplant center order to implement approved work RVU to verify donor blood type at donor ASTS has requested the Joint increases for specific services (primarily site Commission modify its program require- anesthesia). Other highlights of the • Informed Consent Process ments to address these concerns before proposed rule include an extension of • Providing donor information to launching the program. the payment add-on for administration patients of IVIG and changes to the physician • Transplant team meetings The Joint Commission is planning to self-referral or Stark law exceptions. • Quality Assessment and Program apply to Medicare for “deemed status.” If As of this time, Congress had not passed Improvement (QAPI) requirements it seeks and obtains deemed status, certi- legislation to avert the 10 percent fication by the Joint Commission would reduction in Medicare payment that ASTS has requested CMS refrain from be considered equivalent to certification will otherwise occur on January 1, 2008; applying the Interpretive Guidelines by Medicare. The Medicare statute, however, proposals to avert the reduc- until ASTS concerns are resolved. however, prohibits the use of deemed tions are under active consideration by Regardless of whether application accrediting bodies in the approval of both Houses of Congress. of the draft Guidelines is suspended, kidney transplant centers. Therefore, ASTS is hopeful that its concerns will kidney programs would still have to be By Diane Millman, Esq. be addressed before the Guidelines are approved by Medicare. Comments to and Rebecca Burke, Esq. finalized, and will continue to work the Joint Commission standards can Powers, Pyles, Sutter & Verville, PC with Medicare to achieve a reasonable be found on the ASTS website under ASTS Regulatory Counsel and workable certification program. Regulatory. Comments submitted to CMS are available on the ASTS website under OPTN Rules on Living Donors Regulatory. The OPTN has proposed changes to its bylaws and implementation of new www.asts.org Chimera Winter 2008 9 Legislative Report

ASTS Leaders Deliver Strong bill was helped by issuance of a report by Message to Congress the U.S. Department of Justice which In recent months, Congress has been concluded that certain arrangements for consumed with the painstaking devel- donation of kidneys by living donors do opment and negotiation of legislation not constitute “valuable consideration” to reauthorize the State Child Health and explicitly authorized both paired Insurance Program (SCHIP), the vari- donation and list donation, a broader ous user fee programs within the Food interpretation than the legislation. & Drug Administration, and passing an- Extensive efforts to spur negotiations nual appropriations bills which fund the on the paired donation bill in recent federal agencies and programs. As in re- months advanced the bill but have not cent years, final action on both health- yet resulted in final enactment. During care appropriations and a Medicare the legislative fly-in to Washington, package to eliminate a ten percent cut DC, ASTS members met directly with to the 2008 physician fee schedule are Senate and House sponsors of the legis- expected to consume the remainder of lation in an effort to break the impasse. the congressional calendar. Expectations are high for final action by the end of the year. ASTS Legislative (Fly-In) Day On October 23rd, six ASTS transplant “During the legislative Renewed Request for Initial surgeons flew to Washington to meet Organ Donation Act Funding with their legislators and key committee fly-in to Washington, Last fiscal year, the Division of staff on the Society’s legislative priorities. Transplantation (DoT) within the As part of the fly-in, ASTS Legislative DC, ASTS members met Health Resources and Services Committee Chair Dr. Richard Freeman Administration (HRSA) reorganized (MA) was joined by Dr. Hans Sollinger directly with Senate and its 2007 budget to provide for an initial (WI), Dr. Robert Merion (MI), Dr. Kim $2 million in funding for a travel and Olthoff (PA), Dr. Amy Friedman (NY), House sponsors of the subsistence grant program which was one and Dr. Alan Reed (IA) in meetings of three central provisions of the Organ with over 25 congressional offices. Each legislation in an effort to Donation Recovery and Improvement of these surgeons are constituents of Act of 2004. This was necessary because House and Senate Members who are key break the impasse.” initial federal funding of $2 million of decision-makers on the paired new federal funds—originally a donation bill, funding of the Senate proposal—was stripped Organ Donation Act, expansion from the final spending bill when of immunosuppressive drug cov- Congress and the President could erage for Medicare beneficiaries, not agree on new funding levels and other priority issues of the for most federal agencies and Society. programs. The $2 million that DoT redirected to this program Living Kidney Paired was awarded to ASTS and the Donation Bill University of Michigan in a At the beginning of 2007, competitive grant process. expectations for enactment of a bill to clarify the legality Earlier this year, ASTS lead the of paired donation were high effort to secure Senate funding after the tragic death of the of the Organ Donation Act in House sponsor of the legisla- Dr. Robert Merion, Univ. of Michigan, Senator Carl Levin (D-MI), the Senate Labor, Health and tion, Rep. Charlie Norwood Dr. Richard Freeman, Chair, ASTS Legislative Committee, Mr. Peter Human Services, and Education (R-GA). Consideration of the Thomas, ASTS Legislative Counsel Appropriations (L/HHS) spend-

10 Chimera Winter 2008 www.asts.org ing bill of $2 million to increase House Committee on Oversight funding for organ donation & Government Reform in sup- activities. The Senate bill was port of organ donation registries passed on the same day as the and H.R. 3635, the Everson ASTS legislative fly-in and is Walls & Ron Springs Organ headed for conference com- Donation Support Act of 2007. mittee negotiations with the This legislation would help organ House version passed earlier this procurement specialists instantly summer but contains no funds identify willing donors through for the Organ Donation Act. national registries rather than The legislative fly-in presented limited to local or state registries. a timely opportunity to request By creating a national organ and the House Appropriations tissue donor registry resource Committee to adopt the Senate center, donors could make their increase for these organ dona- wishes known and grants would tion programs. It is likely that Ms. Katrina Crist, ASTS Executive Director, Senator Russ Feingold be provided to states to create the final FY 2008 spending bill (D-WI), Dr. Hans Sollinger, Univ. of Wisconsin these registries where they do not will be vetoed by the President exist or build upon those that do. and then a revised version will be “ASTS has spent ASTS has also learned that a com- included in an omnibus appropriations panion Senate bill will be introduced bill at year’s end containing funding considerable time over shortly. for several departments of the federal government. the past several months Conclusion For weeks, congressional Democrats Immunosuppressive Drug educating dozens have been contrasting their priorities Legislation to fund domestic healthcare programs At the end of July, H.R. 3635, the of Congressional offices on with President Bush’s demands for more Comprehensive Immunosuppressive war funds. Congress has sent to the Drug Coverage for Kidney Transplant the merits of this bill.” President, and the President has vetoed, Patients Act of 2007, was introduced the children’s health insurance bill, and in the House by Reps. Camp (R-MI) codifies the requirement that Medicare he has threatened to veto the Health and Kind (D-WI) to extend cover- Part D drug plans cover “all or substan- and Human Services spending bill as age of immunosuppressive drugs for tially all” drugs in six protected classes, well. The SCHIP program, as well as Medicare beneficiaries beyond the including immunosuppressive drugs. most other federal programs, is operat- current 36-month coverage period. The Coverage of these drugs is standard prac- ing under a “Continuing Resolution” or bill eliminates the time limit for kidney tice among state Medicaid programs and “CR” that expires November 16th. A transplant recipients whose Medicare private insurers; however the protections CR temporarily funds programs when coverage is based solely on their ESRD currently offered in the CMS guidance Congress cannot agree to final program status. During the fly-in, ASTS mem- are not guaranteed beyond this year and and agency budgets by October 1st, the bers educated House leaders about the have previously been ignored by some start of the federal fiscal year. It is wide- importance of this legislation and urged drug plans with little risk of sanctions. ly expected that another short term CR them to include the coverage extension This legislative provision, if included will be passed to extend the deadline for in this year’s Medicare package. ASTS in the final Medicare legislation, would congressional action into December. expects that a bipartisan companion bill preserve access to all or substantially all will be introduced in the Senate in the immunosuppressive drugs for Medicare As the year comes to a close, the con- near future. ASTS has spent consider- Part D beneficiaries. So far, the Senate gressional agenda is accelerating. Each able time over the past several months has yet to develop and pass a Medicare day that goes by signals that a legislative educating dozens of Congressional of- bill of its own. ASTS has been educating “train wreck” is every bit as possible as a fices on the merits of this bill. Senate staff about this provision and the successful conclusion to the First Session fly-in provided additional opportunities of the 110th Congress. Protections for to make this case. Immunosuppressive Drugs Under By Peter W. Thomas, Esq. Medicare Part D Organ Donor Registries and Adam R. Chrisney As provision of the House Medicare On September 25, 2007, ASTS sub- Powers, Pyles, Sutter & Verville, PC package which passed in late July, mitted testimony for the record to the ASTS Legislative Counsel www.asts.org Chimera Winter 2008 11 OPTN/UNOS Corner Board of Directors Emphasizes Living Donor Transplant Issues

he OPTN/UNOS Board of developed to address these issues will quire programs performing living donor Directors met Sept. 17-18, 2007, have the same enforceability as deceased transplantation to identify the resources Tin Los Angeles. A key theme of donor policies under the OPTN Final necessary to provide thorough medical the meeting was addressing issues of liv- Rule. The OPTN and UNOS also seek and psychosocial evaluation to have ing donor transplantation in response to to maintain standards consistent with written protocols addressing all phases new responsibilities given to the OPTN Medicare conditions of participation of the living donor process and to abide by the Health Resources and Services for transplant centers recently estab- by those protocols once established. In Administration (HRSA). lished by the Centers for Medicare and addition, they require programs to have Medicaid Services (CMS). a knowledgeable person, independent The Secretary of Health and Human from the medical professionals directly Services has directed the OPTN to de- Living donor kidney, involved in the care of the potential velop policies regarding living organ do- liver bylaws transplant recipient, to be an advocate nors and living organ donor recipients, At its September meeting, The OPTN/ for the needs and interests of the poten- including equitable allocation of living UNOS Board approved new bylaws for tial living donor. donor organs. In a statement published member transplant centers that operate in the Federal Register June 16, 2006, kidney and/or liver programs involving Liver programs currently approved for HRSA determined that OPTN policies living donor transplants. The bylaws re- living donor transplantation will need to supply some additional informa- tion to meet new criteria in the bylaws Kidney Allocation Policy Development (This will not require a completely new application). All kidney programs performing living donor transplants, and A Brief Overview from the OPTN/UNOS Planning Committee any liver programs who wish to do living The OPTN/UNOS Kidney Transplantation Committee has undertaken a donor transplants in the future, will process to achieve equitable allocation as required by the OPTN Final Rule, need to submit a new application. The National Organ Transplant Act, and the Principles of Equitable Organ application forms are currently in devel- Allocation. This process began in 2004 with a series of public hearings and a opment and await government approval. Additional information about the new review of the OPTN Final Rule requirements and Health and Human Services applications and the review process will Program Goals for the OPTN. Based on this review, the Committee considered be provided in coming months. life years following transplant (LYFT) as a concept for kidney allocation. The Committee presented LYFT to the public at a forum held in Dallas, Texas on Living donor informed consent February 8, 2007. During that forum, the Committee solicited feedback from resource document participants about how kidney allocation could be improved and received many The Board approved a resource docu- ment to describe commonalities of excellent recommendations. For a complete description of the recommenda- transplant programs’ protocols for ensur- tions, and a status update on the development of a new kidney allocation, visit ing informed consent for living organ www.optn.org/kars.You can also view a simulation modeling that has been donation. The document can help developed to better understand the concept. inform potential donors in a consistent way about the risks and benefits of living What is LYFT? donation, and can be useful for trans- LYFT is the difference in estimated survival following kidney transplant versus plant programs as they assess and revise estimated survival on dialysis. LYFT is calculated based on a number of objec- their individual protocols. tive medical factors including candidate time on dialysis, body mass index, albu- The OPTN/UNOS Living Donor min levels, diagnosis, age, and sensitization level. For a complete description of Committee developed the resource LYFT, Committee reports, and upcoming events visit www.optn.org/kars. document from the proceedings of Amsterdam and Vancouver consensus Source: The OPTN/UNOS Kidney Transplantation Committee conferences on responsibility to the live organ donor and practices identified in

12 Chimera Winter 2008 www.asts.org HRSA Collaboratives a survey of protocols from programs per- forming living donor transplants. The A Review of Recent Developments document addresses elements of educat- ing potential living donors about the donation process, explaining donor risk and benefits, ensuring proper consent, s part of the Gift of Life The success of the Breakthrough and arranging for follow-up evaluation Donation Initiative, in 2003 Collaboratives has made the following after the donation. It has been posted Athe U.S. Department of Health possible: as an informational resource on the and Human Services Administration OPTN, UNOS and Transplant LivingSM (HHS), Health Resources and Services • 4,146 more organs were trans- web sites and distributed via e-mail to Administration (HRSA) joined with planted in 2006 than in 2003 medical and program staff at programs key national leaders and practitioners performing living donor transplants. from the Nation’s transplantation • 31,184 organs were transplanted and hospital communities to launch in 2006 during 28,923 organ trans- Living donor evaluation the Organ Donation Breakthrough plant operations resource document Collaborative. In 2005 HRSA The Board approved the intent to launched a similar initiative, the • 24, 461 of these organs came from develop a second resource document Organ Transplantation Breakthrough deceased donors, that’s nearly 80 regarding medical and psychosocial Collaborative. The Collaboratives are percent of transplanted organs evaluation of potential living donors intended to identify and promote best and will reconsider the specific content practices in organ donation for adop- • 6,723 organs came from living of the document at its next meeting tion by hospitals and organ procure- donors, that’s 21.6 percent of in February 2008. The Living Donor ment organizations as well as dramati- transplanted organs Committee had initially sought public cally increase access to transplantable comment on this document beginning organs. The aims or goals are for hospi- The Transplant Growth and in July. Resulting comment varied tals, organ procurement organizations Management Collaborative widely, including concerns expressed and transplant hospitals to use best HRSA now seeks to identify and spread that the original proposal was too practices to achieve organ donation the best practices of transplant centers prescriptive upon medical practice. The rates of 75 percent or greater and organs to effectively grow and adapt to the in- Living Donor Committee and the Board transplanted per donor of 3.75. creasing organ supply, thus creating the discussed a number of modifications to Transplant Growth and Management the original proposal. Ultimately the Is a 75 percent goal Collaborative. The goal is to transplant Board approved the introduction and sustainable? 35,000 deceased donor organs in a purpose of the resource document and In October the U.S. Department of single year. To work towards achieving determined that the specific content Health and Human Services (HHS) this goal, HRSA published a report to should be reconsidered by the Living presented awards to 392 of the nation’s identify and share what works across Donor Committee, including an ad- largest hospitals for their success in transplant centers. The report presents ditional period for public comment. increasing organ donation rates at their observations of the best practices of The Committee’s proposed resource facilities. Hospital executives, together selected high-performing transplant document is expected to be distrib- with their partners in 57 federally-desig- centers that have achieved high organ uted for additional public comment in nated organ procurement organizations transplantation rates, while maintain- November. (OPOs), received the Department’s ing expected or higher than expected Medal of Honor for Organ Donation patient and graft survival outcomes. For more information for achieving and sustaining a donation An executive summary of all OPTN/ rate of 75 percent or more of eligible Details of the study can be found on UNOS Board actions is available on donors. www.organdonor.gov. the OPTN web site, www.optn.org, under the “Members” main heading and “In just four years, the number of hospi- By Ginny McBride, RN, MPH, CPTC, “Board of Directors” subhead. More tals that have achieved the 75 percent Director, Breakthrough Collaborative detailed information about the living rate has soared from 55 to 392 – a re- Initiatives, HRSA donor actions is also included in the markable accomplishment.” – Elizabeth “OPTN News” section of the site. M. Duke, Administrator of HHS/HRSA 392 out of 716 eligible hospitals met the By Joel Newman, Assistant Director of 75% goal. Communications, UNOS www.asts.org Chimera Winter 2008 13 Annual Surgical Fellows Symposium An Inaugural Event, November 7-11, 2007 The ASTS is grateful to Astellas for their support of the Symposium.

JJJhhvvbnnnnntree “I think it’s important that ASTS has taken on this Symposium. It brings front and center our mission of fellows’ education.” – Nancy L. Ascher, MD, PhD, Program Faculty, University of California San Francisco Annual Surgical Fellows Symposium “This [fellowship training] is the most important thing that ASTS does, and the most November 7-11, 2007 www.asts.org important thing to ensure the future of our field.” – Allan D. Kirk, MD, PhD, Program Faculty, Emory University School of Medicine

Aloha! Maui, Hawaii was a supe- rior location to premiere the ASTS inaugural Annual Surgical Fellows Symposium. The serene and relaxed atmosphere, coupled with expert fac- ulty is credited with creating a learn- ing environment ripe for transplant surgeons in training. Over fifty fellows in ASTS accredited abdominal fel- lowship training programs and 22 Drs. Peter G. Stock & John C. Magee, Program Session faculty members throughout the U.S. ASTS Fellowship Training Committee Chairs and Canada attended the Symposium. and faculty alike. Immunology, started off with a brief history lesson. infectious disease, kidney allocation, Did the Symposium meet Why? As Allan D. Kirk, MD, PhD, liver organ offers, pancreas allocation expectations? Emory University School of Medicine and ethical issues in transplantation “It’s been a tremendous opportunity and said as he began his presentation on topped the list. We asked a fellow his the faculty participation is awesome. Transplant Immunology, “it’s just good to thoughts on allocation, one of the Transplantation is a small field; it’s know.” With every other presentation more controversial topics, and how impressive and important for junior to follow, fellows were provided with in- this symposium may impact future members to have access to them [senior formation that is not only good to know allocation, he said, “It’s good that these faculty].” – Christopher J. Sonnenday, but also vital to become highly trained, important issues are being addressed. MD, MHS, Fellow, University of qualified transplant surgeons. In the interest of justice, equity, and Michigan Medical Center efficiency, I am sure that the allocation Attendees gleaned individual learn- crisis will be improved by these [Fellows “It’s a good chance to meet and be intro- ing from each presentation and more Symposium] efforts.” – Peter J. Horton, duced to your peers from other programs than a few “hot topics” generated an MD, Fellow, University of Rochester and see how things are done elsewhere.” overwhelming response from fellows Medical Center. – Ajay K. Sahajpal, MD, Fellow, Mayo Clinic, Rochester Friendly Fire! When Peter G. Stock, MD, PhD, Topics such as transplant immunol- University of California San ogy, infectious disease, kidney/liver Francisco, opened the door for discus- allocation, long term management, sion following his presentation on a pancreas acceptance, ethics and lead- new model for kidney allocation the ership skills, to name a few, offered questions came pouring in. In his attendees training and education that presentation, Dr. Stock discussed a they may not have otherwise re- new proposal that the OPTN/UNOS ceived during their fellowship, and/or Faculty-Fellow Networking! Kidney Transplantation Committee individual mentoring. The program Dr. Allan D. Kirk, Emory University School of has developed to achieve more offered over 15 hours of content to Medicine and Drs. Tariq N. Khan (L), Dmitriy equitable allocation; life years fol- address frequently cited gaps in fel- A. Nikitin (R), Fellows, Baylor Regional lowing transplant (LYFT). LYFT is lowship training. The Symposium Transplant Institute the difference in estimated survival

14 Chimera Winter 2008 www.asts.org following kidney transplant versus estimated survival on dialysis. LYFT In pursuit of ASTS’ commitment to is calculated based on a number of define and promote training, each objective medical factors including power point presentation will be made candidate time on dialysis, body mass available via the ASTS website in the index, albumin levels, diagnosis, coming weeks. Video presentations age and sensitization. The rationale will be available through the ASTS behind this proposal sparked a spirited Online Curriculum as well. debate among fellows and faculty. Fellows questioned how the proposed allocation model will work and if the concept is achievable. For answers to these and other questions concerning Symposium Participants LYFT please visit www.optn.org/kars. “It’s important to instill in the next gen- up at this sort of venue.” – Timothy L. Quick on Your Feet! eration of people who do transplants, the Pruett, MD, Program Faculty, University Flashbacks of classroom training and enthusiasm for the breadth of the field; the of Virginia Health Science Center being “put on the spot” came rush- aggregate power of transplantation shows ing back to Andre A. Dick, MD, University of Washington School of Medicine, as he was the first to be Special thanks! called upon on what would continue Astellas Pharmaceuticals for making the Symposium possible to be an impromptu question and answer session by Nancy L. Ascher, through an educational grant. MD, PhD, University of California San Francisco. Dr. Ascher presented Fellowship Training Committee several case studies on management John C. Magee, MD, Chair, 2007-2010 Wendy J. Grant, MD of the liver transplant patient and Peter G. Stock, MD, PhD, Chair, 2005-2007 University of Nebraska Medical Center randomly called on fellows to provide Marian Abouljoud, MD, Co-Chair Mitchell L. Henry, MD a quick assessment and recommend Alan W. Henning, MD The Ohio State University treatment. She challenged fellows to Douglas A. Hale, MD Abhinav Humar, MD utilize their acquired training and to Daniel A. Katz, MD University of Minnesota analyze a situation that will ultimately Douglas G. Farmer, MD Seth J. Karp, MD become even more essential post Gerald S. Lipshutz, MD Beth Israel Deaconess Medical Center fellowship. Dr. Ascher then asked a Jonathan P. Fryer, MD Daniel A. Katz, MD panel of experts to each advise how Ron Shaprio, MD University of Iowa they would treat the patient as well as Ryutaro Hirose, MD Allan D. Kirk, MD, PhD offered her own opinion and ultimate- Sunil K. Geevarghese, MD Emory University School of Medicine ly how UCSF proceeded. Wendy J. Grant, MD John C. Magee, MD University of Michigan Surgical Fellows Symposium Program Charles M. Miller, MD Faculty The Cleveland Clinic Foundation Michael M. Abecassis, MD, MBA Jon S. Odorico, MD Northwestern University University of Wisconsin, Madison Nancy L. Ascher, MD, PhD Kim M. Olthoff, MD University of California San Francisco University of Pennsylvania Ginny L. Bumgardner, MD, PhD Elizabeth A. Pomfret, MD, PhD The Ohio State University Lahey Clinic Medical Center Douglas G. Farmer, MD Timothy L. Pruett, MD University of California Los Angeles University of Virginia Health Sciences Center Stuart M. Flechner, MD Peter G. Stock, MD, PhD The Cleveland Clinic Foundation University of California San Francisco Glickman Urological Institute Randall S. Sung, MD Jonathan P. Fryer, MD University of Michigan Northwestern University Adriana Zeevi, PhD Dr. Nancy L. Ascher, Sunil K. Geevarghese, MD University of Pittsburgh Medical Center University of California San Francisco Vanderbilt University www.asts.org Chimera Winter 2008 15 National Living Donor Assistance Center

he National Living Donor Assistance Center (NLDAC) Director: Twebsite was launched on the Akinlolu O. Ojo, MD, PhD morning of October 17th and by the After registering a living kidney, liver, University of Michigan end of the day, 19 transplant centers had lung or intestine transplant program Ann Arbor, MI registered their living donor programs. with the NLDAC, the authorized Less than 4 weeks later 148 programs transplant professionals file applications Deputy Director: were enrolled and 4 applications for for financial assistance via the NLDAC Robert M. Merion, MD funding were received. Go to www.liv- website on behalf of their living donor University of Michigan ingdonorassistance.org to see how many candidates. Completed applications are Ann Arbor, MI are register as of today. then reviewed by the NLDAC review committee and, if approved, the living Manager: Registration with the NLDAC takes donor is sent a NLDAC credit card Katrina Crist, MBA five minutes and begins the process of with a pre-set credit limit based on American Society of Transplant applying for financial assistance for liv- the amount of funds approved. If the Surgeons ing donors. The NLDAC mission is to patient is eligible to donate after the Arlington, VA reduce financial disincentives to living evaluation is complete, the credit limit organ donation. The ASTS and the on the credit card is increased to cover Research Scientist: University of Michigan were awarded a additional trips to the transplant center Barry A. Hong, PhD, FAACP four year grant from HRSA to establish for the donor surgery and follow up. Washington University School of and operate a nationwide system to The program allows up to $6,000 and 5 Medicine St Louis, MO provide for reimbursement of travel and trips (3 for donor and 2 for an accom- subsistence expenses to eligible individ- panying person) for each prospective Program Coordinator: uals being evaluated and/or undergoing donor. Holly Warren, RN, BA, CPTC living organ donation. The NLDAC office and staff are housed in the ASTS NLDAC Assistant: office located in Arlington, VA. Justine Feighery

ASTS Welcomes NLDAC Team Members to the National Office

Holly Warren, RN, BA, CPTC is Professionals as Councilor at Large and Treasurer. Holly the new Program Coordinator for the will coordinate the day to day activities of the NLDAC. National Living Donor Assistance Center (NLDAC) and Program Manager for the ASTS. Holly has been Justine Feighery is the new assis- in the transplant field for 20 years with tant for the National Living Donor experience in organ procurement as Assistance Center. She graduated well as organ transplantation. She re- from Manhattanville College in ceived her nursing degree from Fresno City College and her New York with a Bachelors Degree bachelor’s degree from Fresno Pacific University in Human in Psychology in May 2006. Justine Resources Management. will provide support to the program manager and program coordinator, Holly worked as a hospital development coordinator at the handling inquiries from transplant centers regarding the California Transplant Donor Network and as a heart trans- NLDAC application process and data collection. She plant coordinator for the University of Maryland Medical will perform general office management and commu- Center. Additionally, Holly has served on the board of nication regarding controlled value card applications, directors for NATCO, the Organization for Transplant travel agency inquiries and centralized reports.

16 Chimera Winter 2008 www.asts.org National Living Donor Assistance Center Q & A

Who is eligible for reimbursement up to $6,000.00 dollars for expenses. from NLDAC? Donors will have access to the funds Eligibility is determined based on through the use of a controlled value donor and recipient household income card, which is similar to a credit card. using a threshold of 300% of the HHS The card allows for all transactions to Poverty Guidelines. If a recipient or a password-protected area of the website on be tracked through electronic central- donor has income greater than 300% behalf of the living donor. ized reports. of HHS Poverty Guidelines and can demonstrate financial hardship, a Who reviews the potential living donor How many trips are allowed per waiver may be requested in writing applications? donation or intended donation? (250 words or less) by the transplant The NLDAC Review Committee will Five. Three of these trips may be for center. The transplant center must review and vote to approve or not ap- the potential living donor and up to provide specific facts describing prove each application. The Review two trips may be for an accompanying significant financial hardship. The Committee Members include a pa- person(s). eligibility guidelines and list of the tient representative from the National preference categories are available on Kidney Foundation, a transplant social How can I contact the NLDAC? the NLDAC website at worker from the Society of Transplant The NLDAC staff is available www.livingdonorassistance.org under Social Workers, a transplant coordina- Monday-Friday 8:00 a.m. -5:00 p.m. the Potential Donors Tab. tor from NATCO, the Organization ET. If you have questions or comments, for Transplant Professionals, and two please feel free to call the NLDAC at What qualifying expenses are NLDAC staff. 703-414-1600 or email us at covered by the NLDAC? [email protected]. Travel, lodging, meals and incidental What is the maximum Federal expenses incurred by the donor and/or reimbursement for qualified expenses Additional information is available at accompanying person(s) as part of: do- during the donation process? www.livingdonorassistance.org nor evaluation; hospitalization for the A potential living donor may receive living donor surgical procedure; and/or medical or surgical follow-up clinic visit or hospitalization within 90 days after the living donation procedure.

How does a Transplant Center register with the NLDAC? Each transplant program must complete an online registration form at livingdonorassistance.org. The program director (surgeon or physi- cian) must attest to ‘good standing status’ with the OPTN and provide the names and email addresses of two transplant professionals authorized to file applications to the NLDAC on behalf of prospective donors. It takes only five minutes to register.

Who files an application to the NLDAC on behalf of potential living donors? The transplant program designated application filers will apply online in a www.asts.org Chimera Winter 2008 17 National Living Donor Assistance Center

How to navigate the NLDAC website: www.livingdonorassistance.org

Transplant centers, candidates and prospective living organ donors can obtain information about the grant, program back- ground, and donor eligibility on the NLDAC website. The easy to navigate site allows transplant programs to efficiently com- plete the registration and application process electronically. The Resources Tab: Users may click on the resource tab to view the Federal Register publica- tion of the final eligibility guide- lines and HRSA response to public The Program Tab: comment. A list of websites that con- This menu allows tain information the user to learn on organ donation more about the and transplanta- program mission, tion is also avail- background, pro- able. gram team and the advisory group.

The Potential Donors Tab: Transplant Centers The eligibility guide- Program directors The Transplant Center Tab: The News and Updates Tab: lines are described in can register their Under this tab, transplant In the months ahead, this section will detail and potential live organ programs centers can register their live be filled with the latest NLDAC press living donors can using the web-based organ programs, learn about coverage, important communications learn more about the registration form. the application process, and and program updates. application process. The OPTN approved login to the password protected Information is orga- program director portal to apply for funds on nized in a Question & (surgeon or physi- behalf of their living donors. Answer format. Links cian) must supply the This tab also provides a list of to other educational names of two profes- all the transplant programs cur- transplant sites that sionals authorized to rently enrolled in the NLDAC provide information file applications and program. on living organ dona- must attest that the tion is also provided. program is in good standing with the OPTN.

18 Chimera Winter 2008 www.asts.org ASTS State of the Art Winter Symposium January 25-27, 2008 Marco Island Marriott Resort, Florida

The High Risk Recipient • January 25-27, 2008 about these fundamental topics. With the increasing success of transplantation, a greater number of candidates may potentially benefit, including those previ- Career Development Symposium • Friday, January 25, 2008 ously considered to be unsuitable. The techniques, management, The Vanguard Committee is committed to addressing non- outcomes, and implications of transplantation in the high-risk clinical issues that are critical to the career development of the recipient will be addressed. junior membership. For 2008, Dr. Marwan Abouljoud, MD, Henry Ford Hospital, will lead an interactive session entitled The 8th Annual State of the Art Winter Symposium: The High Burnout and Work/Life Balance. This topic is essential to Risk Recipient will begin by defining the problem. The Keynote advancing career and professional development Address on Friday afternoon will be a debate entitled “Road to Nowhere: Are There Patients That Should Not Be Transplanted?” Vanguard Committee Mentorship and will include Goran B. Klintmalm, MD, PhD, FACS and Cocktail Reception and Award Presentation: Mark D. Stegall, MD. Additional sessions throughout the sym- Francis Moore Excellence in Mentorship in the Field of posium include “How Do You Make the Bad Not So Bad,” “The Transplantation Surgery Surgically Challenging Recipient,” a surgical video session, and Saturday, January 26, 2008 a series of debates on Sunday morning with controversial topics Back by popular demand, The Vanguard Committee such as retransplantation for recipients with hepatitis C, risk Mentorship Cocktail Hour is designed to develop and foster adjustment of transplant outcomes, and live donor transplants for the academic careers of junior surgical leaders. This year, the pediatric recipients. Vanguard Committee will honor the first two recipients of the ASTS Francis Moore Excellence in Mentorship in the Field of Registration is complimentary for fellows and residents. Transplantation Surgery Award. This award recognizes out- standing mentorship of fellowship trainees and junior faculty Pre-Meeting Course: Practical Knowledge for Transplant Surgeons and will be awarded annually at the Winter Symposium. January 24-25, 2008 This course is designed to address topics rarely encountered Surgical Video Presentations • Sunday, January 27, 2008 in general transplant training. Topics to be discussed include This year’s symposium will feature a video session. Similar to “Obtaining a Position,” “Relationship with your Institution and abstract submissions, the surgical videos were peer reviewed and Career Advancement,” “Running a Practice,” “Managing a Clinical 10 videos chosen for presentation during the symposium. Transplant Program” and “Avoiding Burnout”. This is an unparal- leled opportunity for fellows and junior faculty to learn more Register online at www.asts.org. Medicare 101 What Every Transplant Surgeon Must Know An ASTS First The ASTS Ad Hoc Business Advisory Committee is launching its first Annual ASTS Business Practice Seminar. This invaluable seminar will take place during the ASTS 8th Annual State of the Art Winter Symposium, 8:30 am – 11:30 am, Friday, January 25, 2008. The seminar is for ASTS members only. To register login to www.asts.org.

Why should you attend? Program at a Glance… • Understand Medicare coverage for Paul Kuo, MD, MBA Cost Accounting: You are not an accountant, but you need to know this transplantation • Acquire fundamental Michael Abecassis, Impact of Medicare Acquisition on your professional practice: More Money? knowledge of Organ MD, MBA Transplant Center Regulations: CMS, JCAHO and beyond Acquisition • Be able to enhance Marwan Abouljoud, MD ABC’s of Transplantation: Names and acronyms in the world of transplantation professional and practice Medicare Diane Millman, Esq. Components of the acquisition cost center: What can you bill for? revenue • Become knowledgeable Richard Freeman, MD Introduction to Medicare: Rationale and Expectations of recent CMS regulations and role of Dinesh Ranjan, MD Capturing the revenue: Personal Experience JCAHO ASTS State of the Art Winter Symposium January 25-27, 2008 The High Risk Recipient Marco Island Marriott Resort, Florida

Friday, January 25, 2008 Poster Session with Mini The Surgically Challenging Defining the High Risk Oral Presentations Recipient Recipient Moderators: Robert M. Merion, MD Moderators: Scott A. Gruber, MD, PhD Moderators: Arthur J. Matas, MD and Talia B. Baker, MD and Paolo R. Salvalaggio, MD, PhD and Randall S. Sung, MD 4:00 - 5:30 PM Poster Session 11:20 - 11:40 AM Heart of My Heart: Repair vs. 12:00 -12:05 PM Welcome Transplantation for Congenital Heart Disease Randall S. Sung, MD Career Development Symposium Peter J. Gruber, MD, PhD University of Michigan 5:30 - 7:00 PM Burn Out and Work/Life University of Pennsylvania School of Medicine Balance 12:05 - 12:25 PM Give Me Your Tired, Your Marwan Abouljoud, MD 11:40 AM - 12:00 PM No Guts, No Glory: Poor: Framing the Problem Henry Ford Hospital Challenges in the Intestinal Transplant Recipient Thomas G. Peters, MD Wendy J. Grant, MD Jacksonville Transplant Center 6:30 - 7:30 PM Cocktail Reception University of Nebraska Medical Center

12:25 - 12:45 PM Yesterday When I Was Young: 7:30 - 10:00 PM Dinner & Entertainment 12:00 - 12:20 Up the Lazy River: The Changing High Risk Recipient Kidney/Pancreas in Recipients with Aortoiliac Disease John P. Roberts, MD Saturday, January 26, 2008 Clarence E. Foster, III, MD University of California San Francisco How Do You Make the University of California, Irvine Medical Center 12:45 - 1:05 PM Turn the Beat Around: Impact of Bad Not So Bad? 5:30 - 7:00 PM Vanguard Committee Coronary Artery Disease on Transplant Outcomes Moderators: Robert L. Kormos, MD Mentorship Cocktail Hour George Tellides, MD, PhD and David A. Axelrod, MD, MBA Award Presentation Ceremony: Francis Moore Yale University School of Medicine Excellence in Mentorship in the Field of 8:00 - 8:10 AM Welcome Transplantation Surgery 1:05 - 1:25 PM Mellow Yellow in a Non-Liver David A. Axelrod, MD, MBA Fellow: Hepatitis C in the Extrahepatic Recipient Dartmouth Medical School 7:00 - 10:00 PM Lobster Dinner on the Beach Timothy L. Pruett, MD University of Virginia 8:10 - 8:30 AM Honey, You Shrunk My Tumor: Sunday, January 27, 2008 Downstaging for HCC Surgical Video 1:25 - 1:45 PM Break Francis Y. Yao, MD University of California San Francisco Presentations 1:45 - 2:05 PM The Dog Ate My Pills: Moderators: Kim M. Olthoff, MD Potential Psychosocial Risk Factors 8:30 - 8:50 AM Under Pressure: Pulmonary and Michael J. Englesbe, MD Cheryl Jacobs, LICSW Hypertension In Heart Transplant Recipients The Transplant Center, University of Minnesota-Fairview Abbas Ardehali, MD 7:25 - 7:30 AM Welcome University of California Los Angeles Medical School Michael J. Englesbe, MD 2:05 - 2:25 PM What’s In It for Me: University of Michigan Defining Transplant Benefit 8:50 - 9:10 AM Papa’s Got A Brand New Bag: Robert A. Wolfe, PhD Gastric Bypass and Transplantation 7:30 - 9:30 AM Video Presentations Arbor Research Collaborative for Health J. Wesley Alexander, MD, ScD University of Cincinnati Medical Center 9:30 - 9:45 AM Break Keynote Speaker Session 9:10 - 9:30 AM You Can’t Always Get What You Oral Abstract Moderators: Elizabeth A. Pomfret, MD, PhD Want: The Right Organ for the Right Recipient and Thomas G. Peters, MD Sandy Feng, MD, PhD Presentations Moderators: Mitchell L. Henry, MD University of California San Francisco 2:25 - 2:30 PM Introduction and David A. Gerber, MD Elizabeth A. Pomfret, MD, PhD 9:30 - 9:45 AM Break Lahey Clinic Medical Center 9:45 - 10:45 AM Oral Abstracts

2:30 - 3:30 PM Road to Nowhere: Are There Oral Abstract 10:45 - 11:00 AM Break Patients That Should Not Be Transplanted? Presentations Pro: Mark D. Stegall, MD Moderators: Dixon B. Kaufman, MD, PhD Mayo Clinic Rochester and Ty B. Dunn, MD, MS Con: Goran B. Klintmalm, MD, PhD, FACS Baylor Regional Transplant Institute 9:45 - 11:05 AM Oral abstract presentations

3:30 - 4:00 PM Break 11:05 - 11:20 AM Break

20 Chimera Winter 2008 www.asts.org ASTS State of the Art Winter Symposium January 25-27, 2008 The High Risk Recipient Marco Island Marriott Resort, Florida

Debates Moderators: John P. Roberts, MD and Sean J. Pelletier, MD

A Bird In The Hand: Pediatric Kidney Live Donors Won’t Get Fooled Again: Risky Business: vs. Deceased Donors for Primary Transplant Liver Retransplantation for Hepatitis C Should Transplant Outcomes be Risk Adjusted

11:00 – 11:10 AM 11:30 – 11:40 AM 12:00 – 12:10 PM Pro: H. Albin Gritsch, MD Pro: R. Mark Ghobrial, MD, PhD Pro: Mark A. Schnitzler, PhD University of California Los Angeles University of California Los Angeles Saint Louis University School of Medicine

11:10 – 11:20 AM 11:40 – 11:50 AM 12:10 – 12:20 PM Con: Kenneth A. Andreoni, MD Con: Alan N. Langnas, DO Con: Roger W. Evans, PhD University of North Carolina University of Nebraska Medicine Center Independent Health Care Consultant

11:20 – 11:30 AM Rebuttals 11:50 AM – 12:00 NN Rebuttals 12:20 – 12:30 PM Rebuttals

Pre-Meeting Symposium: Practical Knowledge for Transplant Surgeons

Thursday, January 24, 2008 Running a Practice Managing a Clinical Obtaining a Position Moderators: Mitchell L. Henry, MD Transplant Program Moderators: Thomas G. Peters, MD and Julie K. Heimbach, MD Moderators: John P. Roberts, MD and Randall S. Sung, MD and Sunil K. Geevarghese, MD 3:15 - 3:45 PM Building and Maintaining a 12:30 - 1:00 PM Evaluating the Opportunity Referral Base 8:30 - 9:00 AM Managing Your Program David P. Foley, MD Thomas G. Peters, MD Operations University of Wisconsin-Madison Jacksonville Transplant Center C. Wright Pinson, MD, MBA Vanderbilt University Medical Center 1:00 - 1:30 PM Negotiation 3:45 - 4:15 PM Financial Consideration Seth J. Karp, MD Michael M. Abecassis, MD, MBA 9:00 - 9:30 AM Managing Your Patients Beth Israel Deaconess Medical Center Northwestern University James J. Wynn, MD Medical College of Georgia Relationship with your 4:15 – 5:00 PM Who Wants to be a Millionaire: Reducing your risk of Medical Malpractice 9:30 - 10:00AM Break Institution/Advancement Cliff Rapp, LHRM Moderators: James S. Allan, MD First Professionals Insurance Company 10:00 - 10:30AM What Data is Collected and and Dorry L. Segev, MD How it is Used Friday, January 25, 2008 John C. Magee, MD 1:30 - 2:00 PM Establishing Yourself Clinically University of Michigan Ronald M. Ferguson, MD, PhD Running a Clinical The Ohio State University Research Program 10:30 - 11:00AM Is My Program in Trouble? Moderators: Arthur J. Matas, MD How Increased Scrutiny Affects My Practice 2:00 - 2:30 PM Academic Productivity and Kristin L. Mekeel, MD Timothy L. Pruett, MD John P. Roberts, MD University of Virginia University of California San Francisco 7:30 - 8:00 AM Nuts and Bolts of Running a Clinical Research/Outcomes Program 11:00 - 11:30AM Managing Your Peers 2:30 – 3:00 PM Managing Your Time and Robert M. Merion, MD Goran B. Klintmalm, MD, PhD, FACS Creating Margin University of Michigan Baylor Regional Transplant Institute Douglas W. Hanto, MD, PhD Beth Israel Deaconess Medical Center 8:00 - 8:30 AM How to Run A Clinical Trial 11:30 AM – 12:00 NN Lunch David A. Gerber, MD 3:00 - 3:15 PM Break University of North Carolina

www.asts.org Chimera Winter 2008 1 The American Society of Transplant Surgeons invites you to attend the 8th Annual American Transplant Congress

May 31-June 4, 2008 Metropolitan Toronto Convention Centre Ontario, CANADA

www.atcmeeting.org

Housing and Registration Available January 5, 2008

2008 ATC Planning Committee - ASTS Representatives Executive Committee - Mark Stegall Executive Committee - R. Mark Ghobrial James Allan Yolanda Becker Sandy Feng Thomas Fishbein Abhinav Humar Steven Paraskevas A Passport is required for Travel! As of January 2007, a passport is required to travel between the United States and Canada. Proud of who we are, proud of what we do Show your Pride

The American Society of Transplant Surgeons has launched its online gift shop. Login to the ASTS website and browse through the list of ASTS branded items. Each time you make an ASTS purchase, you strengthen the Society. Show your pride, buy gifts for fellows and colleagues. Shop ASTS at www.asts.org

Shop for polo shirts, baseball caps, coffee mugs, silk women’s scarves and men’s neck ties. Other items for purchase are a hand crafted wooden chair using only maple hardwoods, an ASTS heritage lamp, and an ASTS mat and frame, perfect for your ASTS Fellowship Training Program certificate.

Personalization is also available on certain items.

If you have an idea for a specific item to be added to the site please email us at [email protected] ASTS 2008 Research Awards ASTS has a 23 year history of supporting basic, clinical, and translational research in the field of transplantation and transplant immunobiology. For 2008, the Foundation of the American Society of Transplant Surgeons and its award partners will offer over $775,000 in funding to ASTS members and their trainees.

Deadline: January 8, 2008

Apply online at www.asts.org/awards.

Applications for some awards are accepted on a continual basis throughout the year. Visit www.asts.org for complete details. ASTS Welcomes Sara McCurdy ara McCurdy, Administrative Assistant, is the Snewest addition to the ASTS National Office. Sara grew up outside of Philadelphia, PA and moved to Washington D.C. in August of 2002. She graduated from American University’s School of Public Affairs in May of 2006 with a B.A. in Law and Society and French minor.

While studying at AU Sara tutored underprivileged D.C. area students, and worked for a fundraising agency for non-profits. She took some time off after college to travel throughout Europe. Sara joined the ASTS in August. Her future goals include attend- ing law school and ultimately serving as a lawyer for a non-profit organization. Welcome!

In Memoriam

Dr. H. Myron Kauffman, passed away suddenly, June 26, 2007. A long time resident of Richmond, Virginia, Dr. Kauffman spent 45 years pioneering the practice and science of transplantation. He served as Medical Director and Senior Scientist for the OPTN/UNOS until his passing. In the early 1960s, Dr. Kauffman was the first transplant surgery fellow serving with Dr. David Hume at the Medical College of Virginia (now VCU Health System). He then established kidney transplant programs at the University of Kentucky and the Medical College of Wisconsin. In 1994, he joined UNOS as a part-time medical consultant and later became a senior research scientist and eventually the OPTN Medical Director. Kauffman is remembered for his study of transplant and donor related malignancies. He was instrumental in developing the Transplant Tumor Registry at UNOS, which is now an integral part of the OPTN database. His ongoing research in this area was dedicated to better screening of malignancies in potential donors, as well as better medical management of recipients who develop cancer.

Dr. James S. Wolf, passed away August 6, 2007. Dr. Wolf was among the earliest of transplant profes- sionals dedicated to public education in support of organ donation. He received his Medical Degree from the University of Illinois. He trained in general surgery and transplantation at the Medical College of Virginia, under Dr. David Hume. Dr. Wolf served in many capacities with the OPTN, UNOS and at Northwestern University Medical School. He resigned from UNOS due to heart dis- ease. He received a heart transplant at the Texas Heart Institute in 2001. Dr. Wolf was also a founder and first president of the Coalition on Donation (now Donate Life America) and President and Medical Director of the Regional Organ Bank of Illinois (now Gift of Hope). In his honor, Donate Life America established the “Dr. James S. Wolf Courage Award” in 1999 to recognize individuals who have played a significant national role in educating the public about organ and tissue donation.

www.asts.org Chimera Winter 2008  Corporate Support The American Society of Transplant Surgeons would like to thank the following companies for their generous support of the ASTS in 2007.

Benefactor’s Circle

Founder’s Circle

President’s Circle

Sponsor’s Circle

Associate’s Circle

26 Chimera Winter 2008 www.asts.org Foundation Contributors The American Society of Transplant Surgeons thanks the following individuals for their generous support of the Foundation and its mission (New Contributors in bold)

Distinguished Contributors

Mehmet Haberal • Mark Hardy • Goran Klintmalm • Marc Lorber • Robert Merion • 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 • 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 • J. Wesley Alexander • James Allan • Robert C. Andersen • Massimo Asolati • Clyde Barker • James Bowman III • Cristoph Broelsch • Gordon Burtch • Andrew Cameron • Vincent P. Casingal • Spencer Day • Niraj Desai • James Eason • Carlos O. Esquivel • Lon Eskind • O.H. Frazier • Richard Freeman • Pierre Gianello • Hans Albin Gritsch • Garrett Hisatake • Lynt Johnson • Sang-Mo Kang • Sandip Kapur • Philip Karuman • Masaaki Kimikawa • Richard Knight • Babuaro Koneru •Dong Sik Kim • Tomasz Kozlowski • Max Langham • Hyung Lee • Robert Madden • Joren Madsen • George Mazariegos • Robert McMillan • Robert Mendez • Bhargav Mistry • Elijah Mobley • Susan Orloff • Guillermo Solorzano Peck • Ponnusamy Mohan • Robert Montgomery • Martin Mozes • Kadiyala Ravindra • Alan Reed • Gonzalo Rodriguez-Laiz • Richard Ruiz • Paul Russell • Benjamin Samstein • Juan Sanabria • Eduardo Santiago • Randolph Schaffer III • Ashish Shah • Mark Slaughter • Roberto C. Lopez-Solis • Randall Sung • Miguel Tan • Nicholas Tilney • Georgios Tsoulfas • Jeffrey Veale • Yohichi Yasunami • Serdar Yilmaz

Two ways to contribute • www.asts.org, through “renew my membership function • Check made payable to the ASTS Foundation

www.asts.org Chimera Winter 2008 7 Job Board This is an abbreviated listing of the job posting currently available on the ASTS website. To view the complete and more detailed information visit www.asts.org and login to the Member’s Portal using your username and password.

Avera McKennan Hospital Southern Illinois University: and University Health Center: Kidney and Pancreas Transplant Hepatologist Transplant Surgeon Submit curriculum vitae and letter of Submit cover letter and curriculum interest to: Ann Burns vitae to: Edward J. Alfrey, M.D. Director Physician Recruitment Professor of Surgery Avera McKennan Hospital & University Chair, Division of General Surgery Health Center Program Director, General Surgery 800 East 21st Street Residency Training Program Sioux Falls, SD 57105 Southern Illinois University Phone: 605 371.5883 School of Medicine Fax: 605 371.5886 701 N. First Street Email: [email protected] P.O. Box 19638 Georgetown University Springfield, IL. 62794-9638 Avera McKennan Hospital Hospital: Director of Kidney, Phone: 217 545.7240 and University Health Center: Pancreas Transplant Fax: 217 545.0040 Transplant Surgeon Submit curriculum vitae to: Email: [email protected] Submit curriculum vitae and letter of Lynt B. Johnson, MD, MBA interest to: Ann Burns Chief, Division of Transplant and The Intermountain Director Physician Recruitment Hepatobiliary Surgery Transplant Program: Multi- Avera McKennan Hospital & University Georgetown University Hospital Organ Transplant Surgeon Health Center Transplant Institute Submit letter of interest and curricu- 800 East 21st Street 3800 Reservoir Road, NW lum vitae to: Sioux Falls, SD 57105 2 Main LeGrand Belnap, MD, FACS Phone: 605 371.5883 Washington, DC 20007 Chief, Intermountain Fax: 605 371.5886 Email: [email protected] Transplant Program Email: [email protected] Belnap and Van der Werf Surgical Kaleida Multi-Organ Assoc., LLC Beth Israel Deaconess Transplant Center, 1250 East 3900 South, #220 Medical Center: Multi-Organ Buffalo General Hospital: Salt Lake City, UT 84124 Transplant Surgeon Transplant Surgeon Phone: 801 262.9782 Submit curriculum vitae and letters of Submit a letter of interest, references Fax 801 262.8632 recommendation to: and curriculum vitae to: Douglas W. Hanto, MD, PhD Mark Reza Laftavi, MD, FACS University of Minnesota Chief, Division of Transplantation Chief, Transplant Services Medical School: Beth Israel Deaconess Medical Center Buffalo General Hospital Assistant Professor, 110 Francis Street, Suite 7 100 High Street Associate Professor, Boston, MA 02215 Buffalo, New York 14203 Professor, Phone: 617 632.9810 Phone: 716 859.1345 Tenure-track/tenured or Fax: 617 632.9820 Fax: 716 859.4631 clinical scholar track E-mail: [email protected] E-mail: [email protected] Submit an application to the University of Minnesota Online Duke University Medical Center: Newark Beth Israel Employment website to Requisition # Transplantation Surgeon Medical Center: 148909 (tenure-track, clinical scholar Submit curriculum vitae to: Transplant / Vascular Surgeon track) or #148911 (tenured) at http://em- Paul C. Kuo, MD, MBA For more information or to apply: ployment.umn.edu attach a curriculum Chief, Division of General Surgery www.sbhcscareers.com and enter job vitae, bibliography and three references. Duke University Medical Center #21497 Also submit materials to: Box 3522 David E. R. Sutherland, MD, PhD Durham, NC 27710 Search Committee Chair

28 Chimera Winter 2008 www.asts.org Division of Transplantation, Wayne State University: Department of Surgery Kidney Transplant Surgeon Please Note… University of Minnesota Medical School Submit curriculum vitae to: The ASTS now offers 420 Delaware St SE, MMC 195 Scott A. Gruber, MD, PhD, MBA, Minneapolis, MN 55455 FACS, FCP the option of posting a Email: [email protected] Professor and Chief Section of Transplant Surgery position for 30, 60 or Baystate Medical Center: Wayne State University 90 days. Kidney Transplant/Vascular School of Medicine Access Surgeon Director, Organ Transplant Program Submit curriculum vitae to: Harper University Hospital George Lipkowitz, MD 3990 John R, Suite 400 Contact the ASTS Director of Renal Transplant Detroit, MI 48201 national office for details. Phone: 413 747.4170 Fax 413 747.4177 Phone: 313 745.7319 Email: [email protected] Fax: 313 993-0595 E-mail: [email protected]

• C o l l abo r at i v e e T H i cs C o n f e r e n c e • Call For Abstracts Dilemmas & Struggles Abstract Submission Deadline: January 7, 2008, 6:00 P.M. EST in Transplantation The American Society of Transplant Surgeons (ASTS) along Ethics, with the Academy of Psychosomatic Medicine (APM), and the Chicago Transplant Ethics Consortium (CTEC) are Psychosocial now inviting abstract submissions for a jointly planned, Considerations, multidisciplinary meeting. & Policy Submit abstracts to [email protected] This is a first of its kind collaboration to provide a national forum for transplant surgeons and physicians, psychiatrists, psychologists, ethicists and others with an interest in transplant ethics to discuss and debate issues in the field of solid organ transplantation.

April 4-6, 2008 For a complete abstract overview and list of potential topics visit the ASTS website site, www.asts.org. Chicago, IL Send questions to [email protected] Register Online: www.cme.northwestern.edu/conferences

www.asts.org Chimera Winter 2008 9 New Members ASTS Welcomes New Members.....

Avinash A. Garwal, MD Joshua D. Mezrich, MD Emory University University of Wisconsin School of Medicine Atlanta, GA Madison, WI

Edip Akpinar, MD Kian A. Modanlou, MD University of Miami Saint Louis University Jackson Memorial Hospital Saint Louis, MO Miami, FL Seth C. Narins, MD, PhD Thomas Aloia, MD Columbia University The Methodist Hospital New York Presbyterian Hospital Houston, TX New York, NY

Paul B. Alvord, MD Justin H. Nguyen, MD Northwestern Memorial Hospital Mayo Clinic Chicago, IL Jose Luciano Farias-Jimenez, MD Jacksonville, FL McAllen Medical Center Emad H. Asham, MD, FRCS McAllen, TX Khaled A. Obeidat, MD UCLA-Dumont Transplant Center Ohio State University Los Angeles, CA Michael H Gallichio, MD Columbus, OH Albany Medical Center Federico N. Aucejo, MD Albany, NY Srikanth Padma, MD Cleveland Clinic Foundation Carolinas Medical Center Cleveland, OH Marc R. Garfinkel, MD Charlotte, NC The University of Chicago Arie Blitz, MD Chicago, IL Jared R. Pennington, PA-C, MHS University Hospitals Case Medical Center Summa Health System Cleveland, OH Mark J. Hill, MD Akron, OH University of Minnesota Justin M. Burns, MD Minneapolis, MN Dana K. Perry, MD Mayo Clinic Mayo Clinic Rochester, MN Raja Kandaswamy, MD, FACS Rochester, MN University of Minnesota Prosanto Chaudhury, MD Minneapolis, MN Virgilio G. Petero, MD Northwestern Memorial Hospital University of Texas Health Chicago, IL Wojciech Lisik, MD, PhD Science Center at Houston Medical University of Warsaw Houston, TX Ana C. del Pozo, MD Warsaw 02006, Poland Mount Sinai Medical School Eduardo Jose B. Ramos, MD, PhD New York, NY Jayme E. Locke, MD, MPH Hospital de Clinicas Universidade Johns Hopkins Medical Institutions Federal doParana Roger R. Denny, MD Baltimore, MD Curitiba, Brazil Carolinas Medical Center Charlotte, NC Julian E. Losanoff, MD David J. Rea, MD Wayne State University Mayo Clinic Detroit, MI Rochester, MN

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].

30 Chimera Winter 2008 www.asts.org Markus Rentsch, MD Calendar University of Munich The ASTS is pleased to coordinate with other professional Campus Grosshadern organizations in order to provide information concerning events Munich, Germany that might be of interest to our members. Jason A. Rolls, MD Columbia University February 2008 New York, NY February 09, 2008 Upcoming ASTS Events New Advances in Solid Organ Transplantation January 25, 2008 The Dana on Mission Bay Ajay K. Sahajpal, Bsc, MD Medicare 101: What Every San Diego, CA Mayo Clinic Transplant Surgeon Must Know Telephone: 858 587.4325 Marco Island, FL Rochester, MN www.scripps.org/conferenceservices

January 25-27, 2008 Ashish Saharia, MD February 14-17, 2008 8th Annual State of the Art Methodist University Hospital 8th International Conference on New Trends Winter Symposium Memphis, TN in Immunosuppression & Immunotherapy The High Risk Recipient Berlin, Germany Pre-Meeting Course (Jan. 24-25) Scott C. Silvestry, MD www.kenes.com/immuno Practical Knowledge for Transplant Surgeons Thomas Jefferson University Hospital Marco Island, FL Philadelphia, PA February 28-March 2, 2008 Canadian Society of Transplantation Annual April 4-6, 2008 Anton I. Skaro, MD, PhD Scientific Meeting Ethics Symposium Northwestern Memorial Hospital Fairmont Tremblant Dilemmas and Struggles in Transplantation: Chicago, IL Mont-Tremblant, Quebec Ethics, Psychosocial Considerations, and Policy www.transplant.medical.org/annual_meeting.htm Chicago, IL Hiroshi Sogawa, MD Mount Sinai Medical Center April 2008 May 31-June 4, 2008 New York, NY April 2-6, 2008 American Transplant Congress National Kidney Foundation www.atcmeeting.org Toronto, ON Chintalapati Varma, MD, FRCS 2008 Spring Clinical Meetings Gaylord Texan Geisinger Medical Center Dallas, TX Danville, PA Sydney, Australia www.nkfclinicalmeetings.org Telephone: 61-3-941-70888 www.transplantation2008.org/ Dionisios Vrochides, MD, PhD April 9-12, 2008 Thessaloniki, Greece ISHLT 28th Annual Meeting & Scientific Sessions August 11-14, 2008 Hynes Convention Center NATCO’s 33rd Annual Meeting Mark R. Wakefield, MD Boston, MA Sheraton Boston University of Missouri www.ishlt.org/meetings/futureMeetings.asp Boston, MA Columbia, MO Phone: 913 492.3600 May 2008 www.natco1.org/news_calendar/calendar.htm Jason A .Wertheim, MD, PhD May 30-June 4, 2008 Massachusetts General Hospital American Transplant Congress October 2008 Boston, MA Toronto, Canada October 12-16, 2008 www.atcmeeting.org 94th Annual Clinical Congress Kenneth J. Woodside, MD American College of Surgeons August 2008 San Francisco, CA University of Michigan August 10-14, 2008 www.facs.org Ann Arbor, MI XXII International Congress Email: [email protected] of The Transplantation Society George Wu, BS, MD Mount Sinai Medical Center, RMTI Please Note… New York, NY ASTS Business Meeting to be held Saturday, January 26, 2008 at 12:30 pm at the Gary S. Xiao, MD Marco Island Marriott during the 8th Annual State of the Art Winter Symposium Drexel University College of Medicine in Marco Island, Florida; Salon A-D, Lobby Level; following the adjournment of Philadelphia, PA the afternoon session. A boxed lunch will be served. See page 5 for details.

www.asts.org Chimera Winter 2008 1 ASTS 8th Annual State of the Art Winter Symposium The High Risk Recipient January 25-27, 2008 Marco Island Marriott Resort, Florida

Pre-Registration deadline: Friday, January 10, 2008 Pre-Meeting Course: Practical Knowledge for Transplant Surgeons Register Online January 24-25, 2008 Held in conjunction with the NATCO Symposium at www.asts.org for the Advanced Transplant Professional

ASTS National Office 2461 South Clark Street Suite 640 Arlington, VA 22202