Transplant Evaluation # 4: Selection Process & the Transplant Database

In our last post in this series, we talked about the challenges of getting ready for the selection committee meeting. As a transplant coordinator, the selection committee meeting is your opportunity to advocate for your patient that you have been nurturing from the initial evaluation until this upcoming meeting. Now that your patient has completed the pre-transplant evaluation which I covered in the first post in this series, the decision of whether or not to add them to the waiting list must be made.

During the listing meeting, medical information will be shared with members of the multi-disciplinary team, highlighting the key factors that the committee will consider in their decision.

Often times, the ability to view primary source documentation will be essential to not only the decision-making process but also to guide any further assessment that might be necessary. An example of this is when there is a question of the patient's cardiac status. As many programs receive cardiac opinions from a number of different cardiologists, it is only at the listing meeting that your cardiology consultant that works closely with your team may have the opportunity to review the primary source documents of the testing results. Having this documentation incorporated into your transplant database provides a more efficient and consistent approach to the management of this difficult patient population.The ability to have this accessibility requires efficient data management workflow and tools prior to the meeting to ensure that the information is available.

Should the committee decide that additional testing or consults are necessary, it is important to document this in the medical record. Efficient methods of scheduling, obtaining these results and having them entered into the medical record for future discussion at a listing meeting is essential.

Once the committee makes their decision, documentation in the patient's medical record must reflect the committee's decision and the reason the patient met or did not meet the program's selection criteria. Auditors will look for this evidence during a review of the program. Furthermore, the patient must be notified with 10 days of the decision to list, or any subsequent status changes. Having your transplant database automatically generate these letters will improve efficiency while improving compliance.

About the Author: Dr. John Daller, MD, PhD, FACS

As a former Director of several transplant programs, Dr. Daller has expertise in all aspects of transplant program management, as well as hospital program development including clinical, regulatory, business and administrative leadership via his company Strategic Illuminations. He consults in the area of medical legal review, due diligence and scientific evaluations, as well as utilization review via Daller Consulting. He is also Chief Medical Officer of Concordia Valsource, LLC which provides consultative services to developing biopharmaceutical companies and to Venture Capital groups investing in the health and life sciences. Previously, Dr. Daller was Vice President for Medical Programs in the Transplant Business Unit of Genzyme Corporation.