It is time for board certification in transplant pharmacotherapy

To the Editor: Board certification for transplant pharmacists is essential to ensure uniform delivery of medication therapy management and access to pharmacotherapy expertise for all solid organ transplant (SOT) donors and recipients. Transplant pharmacy has expanded tremendously since the first practice was described in 1976.1Mitchell J Pharmacist involvement as a member of a renal transplant team.Am J Hosp Pharm. 1976; 33: 55-58PubMed Google Scholar It is now clear that transplant pharmacists are a staple of the multidisciplinary transplant team. Board certification is a well-recognized method amongst physicians for establishing a level of clinical expertise. The Board of Pharmacy Specialties (BPS) was established in 1976.2Board of Pharmacy Specialties. History section. https://www.bpsweb.org/about-bps/history/. Accessed May 4, 2018.Google Scholar Currently, there are over 35 000 pharmacists worldwide who are board certified in general or specialized areas and can take a number of paths to certification (Figure 1). Centers for Medicare and Medicaid Services (CMS)3Anonymous, Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 405, 482, 488, and 498 Medicare ProgramHospital conditions of participation: requirements for approval and re-approval of transplant centers to perform organ transplants; final rule.Fed Reg. 2007; 72: 15197-15279PubMed Google Scholar and United Network for Organ Sharing (UNOS)4Organ procurement and transplantation network (OPTN) policies. Effective date: December 12, 2017. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. Accessed May 4, 2018.Google Scholar regulations significantly increased the need for transplant pharmacist involvement in the multidisciplinary team. Transplant pharmacists now “care for patients throughout all phases of transplant, of all ages, and in various health care settings.”5Board of Pharmacy Specialties. Board of Pharmacy Specialties receives petition to recognize solid organ transplantation pharmacy as a specialty. https://www.bpsweb.org/2018/04/04/board-of-pharmacy-specialties-receives-petition-to-recognize-solid-organ-transplantation-pharmacy-as-a-specialty/. Accessed May 4, 2018.Google Scholar Transplant pharmacist practice clearly requires specialized skills, as previously detailed in this journal.6Alloway RR Dupuis R Gabardi S et al.Evolution of the role of the transplant pharmacist on the multidisciplinary transplant team.Am J Transplant. 2011; 11: 1576-1583Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Due to the demand for pharmacists to fulfill the CMS accreditation standards, some transplant programs may meet the need by identifying pharmacists without specific SOT training or experience due to lack of fully trained personnel and/or funding resources. While these pharmacists are filling a needed role and may provide excellent care as they gain experience, it is irrefutable that a pharmacist with formal postgraduate training or extensive experience in transplantation has distinct advantages. To standardize the field, board certification is a means to ensure competencies for pharmacists caring for transplant patients and to allow centers to establish proficiency standards. This issue ultimately impacts all those individuals who rely on transplant pharmacists, including patients, providers, allied health professionals, and transplant administrators. There are a number of potential disadvantages to board certification. Variable practice patterns and organ-specific nuances, which are difficult to assess through a written exam, are frequently cited as limitations. However, there are numerous well-established concepts within transplant pharmacotherapy, including immunosuppressants, antimicrobial agents, and biologics pharmacokinetics/dynamics, pharmacology, drug-drug interactions, drug-disease interactions, and cost-containment strategies, that can and should be assessed through written competencies. Further, knowledge related to CMS and UNOS regulatory requirements, as well as Joint Commission standards, are essential to center certification, and will be covered by the credentialing process. Finally, the continuing education (CE) resources associated with board certification will be available to all pharmacists and will be a requirement for those that seek board recertification without retesting. The benefit of increased availability to timely CE is that it will ensure pharmacists have access to education that will aid in their knowledge of current immunosuppression management strategies, the latest pharmacotherapy literature related to care of SOT patients, and pertinent topical issues within SOT regardless of their choice to seek certification.2Board of Pharmacy Specialties. History section. https://www.bpsweb.org/about-bps/history/. Accessed May 4, 2018.Google Scholar This group strongly believes this is the right step forward for the transplant pharmacist profession and will bring us closer to the ultimate goal of ensuring all donors and recipients have access to highly trained and knowledgeable transplant pharmacists. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.