Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States

Goldberg, David S.; Kallan, Michael J.; Fu, Le; Ciccarone, Mariavita; Ramírez, J. Roldán; Rosenberg, P. H.; Arnold, James A.; Segal, Greg; Moritsugu, Kenneth P.; Nathan, Howard M.; Hasz, Rick D.; Abt, Peter L.

doi:10.1111/ajt.14391

Cited by 53 publications

(66 citation statements)

References 33 publications

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“…4 Notably absent from this definition is the requirement for the potential donor to be declared brain dead. This is despite good performance in the later phases of the donation process, such as a consent rate that has been ≥ 85% for many years now.…”

Section: It Has Been Reported That Variation In Eligible Deaths Betweenmentioning

confidence: 99%

“…This is despite good performance in the later phases of the donation process, such as a consent rate that has been ≥ 85% for many years now. 4,5 Furthermore, with the current focus on geographic disparities in organ allocation, 20,21 we believe that the expanded application of geostatistical methods in the transplant literature will provide valuable insights going forward. In addition, there has been increased scrutiny of all referrals by the medical director to ensure that no potential donors are ruled out inappropriately before the declaration of brain F I G U R E 2 Geographic variability in deaths from the top 5 causes of death in organ donors (blunt trauma, gunshot wounds, drug overdose, cerebrovascular accidents, and cardiovascular disease) per 1000 population stratified by quintile.…”

Section: It Has Been Reported That Variation In Eligible Deaths Betweenmentioning

confidence: 99%

“…[3][4][5][6][7] One proposed explanation for this variation is regional differences in rates and causes of deaths. [3][4][5][6][7] One proposed explanation for this variation is regional differences in rates and causes of deaths.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7]12 This study was undertaken to investigate the pattern of geographic variation in OPO-reported eligible death rates and to evaluate whether this pattern follows that of the geographic variation in more objectively determined measures such as mortality rates and causes of death. [3][4][5][6][7]12 This study was undertaken to investigate the pattern of geographic variation in OPO-reported eligible death rates and to evaluate whether this pattern follows that of the geographic variation in more objectively determined measures such as mortality rates and causes of death.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of geographic variability in mortality and eligible deaths between organ procurement organizations

Cannon

Jones

Davis

et al. 2019

American Journal of Transplantation

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Eligible deaths are currently used as the denominator of the donor conversion ratio to mitigate the effect of varying mortality patterns in the populations served by different organ procurement organizations (OPOs). Eligible death is an OPO-reported metric rather than a product of formal epidemiological analysis, however, and may be confounded with OPO performance. Using Scientific Registry of Transplant Recipients and Centers for Disease Control and Prevention data, patterns of mortality and eligible deaths within each OPO were analyzed with the use of formal geostatistical analysis to determine whether eligible deaths truly reflect the geographic patterns they are intended to mitigate. There was a 2.1-fold difference in mortality between the OPOs with the highest and lowest rate s, with significant positive spatial autocorrelation evident in mortality rates (Moran I = .110; P < .001), meaning geographically proximate OPOs tended to have similar mortality rates. The eligible death ratio demonstrated greater variability, with a 4.5-fold difference between the OPOs with the highest and lowest rate s. Contrary to the pattern of mortality rates, the geographic distribution of eligible deaths among OPOs was random (Moran I = −.002; P = .410).This finding suggests geographic patterns do not play a significant role in eligible deaths, thus questioning its continuing use in OPO performance comparisons. K E Y W O R D Sclinical research/practice, donors and donation, health services and outcomes research, organ procurement, organ procurement and allocation, organ procurement organization, registry/ registry analysis

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Section: It Has Been Reported That Variation In Eligible Deaths Betweenmentioning

confidence: 99%

Section: It Has Been Reported That Variation In Eligible Deaths Betweenmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patterns of geographic variability in mortality and eligible deaths between organ procurement organizations

Cannon

Jones

Davis

et al. 2019

American Journal of Transplantation

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“…This reported disparity, and much of the controversy, has been based on the metric of Model for End‐Stage Liver Disease (MELD) score at transplant, or allocation Model for End‐Stage Liver Disease (aMELD) score. However, just as ecosystems have unique characteristics, interregional and intraregional variations in supply and demand also have specific attributes, such as population death rate and burden of liver disease, uneven granting of exception scores, organ procurement organization (OPO) efficiency and performance, center behavior, and competition among local transplant centers …”

mentioning

confidence: 99%

Think global, act local: Responsibility for the liver transplant candidate

Abt

Olthoff

2018

Liver Transpl

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Assessment of National Organ Donation Rates and Organ Procurement Organization Metrics

et al. 2021

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IMPORTANCEOrgan transplant is a life-saving procedure for patients with end-stage organ failure. In the US, organ procurement organizations (OPOs) are responsible for the evaluation and procurement of organs from donors who have died; however, there is controversy regarding what measures should be used to evaluate their performance.OBJECTIVE To evaluate OPO performance metrics using combined mortality and donation data and quantify the associations of population demographics with donation metrics. DESIGN, SETTING, AND PARTICIPANTSThis national cohort study includes data from the US organ transplantation system from January 2008 through December 2017. All individuals who died within the US, as reported by the National Death index, were included.EXPOSURES Death, organ donation, and donation eligibility. MAIN OUTCOMES AND MEASURESEvaluation of the variation in donation metrics and the use of ineligible donors by OPO and demographic subgroup. RESULTSThis study included 17 501 742 deaths and 75 769 deceased organ donors (45 040 men [59.4%]; 51 908 White individuals [68.5%]). Of these donors, 15 857 (20.9%) were not eligible, as defined by the OPOs. The median donation metrics by OPO were 0.004 (range, 0.002-0.012) donors per death, 0.89 (range, 0.68-1.30) donors per eligible death, and 0.72 (range, 0.57-0.86) eligible donors per eligible death. The OPOs in the upper quartile of the overall eligible donors per eligible death metric were in the upper quartile of annual rankings on 90 of 140 occasions (64.3%). There was little overlap in top-performing OPOs between metrics; an OPO in the upper quartile for 1 metric was also in the upper quartile for the other metrics on 37 of 570 occasions (6.5% of the time). The median donor eligibility rate, defined as the number of eligible donors per donor, was 0.79 (range, 0.61-0.95) across OPOs. Age (eg, 65 to 84 years, coefficient, −0.55 [SE, 0.03]; P < .001; vs those aged 18 to 34 years), sex (male individuals, −0.09 [SE, 0.02]; P < .001; vs female individuals), race (eg, Black individuals, 0.35 [SE, 0.02]; P < .001; vs White individuals), cause of death (eg, central nervous system tumor, 0.48 [SE, 0.08]; P < .001; vs anoxia), year (eg, 2016-2017: −0.10 [SE, 0.03]; P < .001; vs 2008-2009), and OPO were associated with the use of ineligible donors; OPO was a significant factor associated with performance in all metrics (χ 2 56 , 500.5; P < .001; coefficient range across individual OPOs, −0.15 [SE, 0.09] to 0.75 [SE, 0.09]), even after accounting for population differences. Female and non-White individuals were significantly less likely to be used as ineligible donors. CONCLUSIONS AND RELEVANCEWe demonstrate significant variability in OPO performance rankings, depending on which donation metric is used. There were significant differences in OPO performance, even after accounting for differences in potential donor populations. Our data suggest significant variation in use of ineligible donors among OPOs, a source for increased donors. The performance of OPOs should be evaluated usin...

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Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States

Cited by 53 publications

References 33 publications

Patterns of geographic variability in mortality and eligible deaths between organ procurement organizations

Patterns of geographic variability in mortality and eligible deaths between organ procurement organizations

Think global, act local: Responsibility for the liver transplant candidate

Assessment of National Organ Donation Rates and Organ Procurement Organization Metrics

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