Improving OPO performance through national data availability

Doby, Brianna; Boyarsky, Brian J.; Gentry, Sommer E.; Segev, Dorry L.

doi:10.1111/ajt.15508

Cited by 16 publications

(24 citation statements)

References 8 publications

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“…Without good evidence of the degree to which growth is possible and the areas in which it can best be achieved, performance initiatives will at best be haphazard and inefficient 22 . With reliable data, however, any process improvements can readily be evaluated by their results 23‐25 …”

Section: Discussionmentioning

confidence: 99%

Public discourse and policy change: Absence of harm from increased oversight and transparency in OPO performance

Doby

Ross-Driscoll

Shuck³

et al. 2021

American Journal of Transplantation

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The Centers for Medicare and Medicaid Services announced changes to the Final Rule for organ procurement organizations (OPOs) in November 2020, after a 23‐month period of public debate. One concern among transplant stakeholders was that public focus on OPO underperformance would harm deceased donation. Using CDC‐WONDER data, we studied whether donation performance dropped during the era of public debate about OPO reform (December 2018–February 2020). Overall OPO performance as measured relative to cause, age, and location‐consistent deaths rose by 12.3% in 2019, compared to a median annual change of 2.5% 2009–2019. Organ recoveries exceeded seasonally adjusted forecasts by 4.2% in the first half of 2019, by 8.1% following the Executive Order issuing a mandate for OPO metric reform, and by 14.1% between the Notice of Public Rule Making and the onset of COVID‐19‐related systemic disruptions. We describe changes in donor phenotype in the period of increased performance; improvement was greatest for older and donation after cardiac death (DCD) donors, and among decedents who did not have a drug‐related mechanism of death. In summary, performance during an era of intense public debate and proposed regulatory changes yielded 692 additional donors over expectations, and no detriment to organ donation was observed.

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Section: Discussionmentioning

confidence: 99%

Public discourse and policy change: Absence of harm from increased oversight and transparency in OPO performance

Doby

Ross-Driscoll

Shuck³

et al. 2021

American Journal of Transplantation

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“…In effect, the question is not simply about the prospective donor's culture but also the culture of their local OPO. Given the paucity of publicly shared OPO process data, 12 the quality of care dispensed in managing donation referrals and family approaches in minority cases cannot be evaluated by researchers (eg, use of ethnicity-matched requestors, culturally targeted public education). The hazard of normalizing an observed discrepancy in "donation rate" is that we may accept poor care as a feature of a given donation service area (DSA) rather than a flaw in a given OPO's process.…”

Section: Role Of Ris K Adj Us Tment In He Alth C Are and Tr An S Plmentioning

confidence: 99%

“…The paper did not focus on inter-and intra-OPO differences in donation rates by race/ethnicity, and it relied on eligible death data to define donation rates, a measure that has been uniformly criticized as a poor metric of organ donation rates/OPO performance. [1][2][3][4]12 Nevertheless, there is a body of literature that suggests there are lower donation rates among racial and ethnic minorities, but this fact alone does not justify its inclusion in risk adjustment.…”

Section: R Acial D Ifferen Ce S In Org An Recovery R Ate Smentioning

confidence: 99%

“…Unfortunately, such data on different process measures within OPOs are currently not available to researchers. 12 We also evaluated the DSA-level differences in donation rates by race/ethnicity nationally in 2017, restricted to white vs black CALC deaths due to insufficient numbers of deaths of Hispanics or Asians in several DSAs in 2017. The numerator was donors per OPTN/UNOS data (ie, patient with at least one organ recovered with the intent to transplant), and the denominator was CDC data as described previously.…”

Section: Data Challeng Ing Minorit Y S Tatus a S A Fixed Fac Tor Inmentioning

confidence: 99%

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Rejecting bias: The case against race adjustment for OPO performance in communities of color

Goldberg

Doby

Siminoff

et al. 2020

American Journal of Transplantation

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In December of 2019, the Centers for Medicare and Medicaid Services (CMS) put out a notice of proposed rule‐making for 42 CFR Part 486, specifically the section that covers the organ procurement organization (OPO) Conditions for Coverage. Most crucially, the proposed rule included two new OPO performance metrics using objective, standardized data from the Centers for Disease Control and Prevention (CDC). These new metrics would employ a denominator that included inpatient deaths from certain causes that could lead to organ donation, rather than the current unverifiable eligible death metric. Although there has been near‐uniform support for replacing the eligible death denominator with CDC data, a source of contention is CMS's proposal not to adjust risk for race in their OPO outcome. Nonetheless, there have been calls for race and ethnicity to be included as risk‐adjusted variables in the CMS donation metric. Herein, we lay out an argument as to why inclusion of race and ethnicity as risk adjustment variables in an OPO performance metric is not only statistically suspect but also will hide the inequities that are detrimental to optimal system performance and assurance that all patients have timely access to donation.

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“…In the United States, OPOs are responsible for evaluating donor referrals, obtaining consent for organ donation, overseeing donor management, and facilitating organ procurement and distribution; as such, the donation process is critically dependent upon OPOs as facilitators of donor identification, organ optimization, and eventual transplantation. [14][15][16] For many years, OPO-level practices have been poorly understood as the transplant community lacks a national system that captures and reports OPO-level data, and existing evaluation metrics fail to objectively and transparently reflect OPO performance, particularly toward non-ideal donor groups. 14,17,18 In a recent investigation, our group found that OPOs vary widely in willingness to pursue and utilize non-ideal donor lungs, suggesting that interventions to standardize practices across OPOs and non-ideal donor groups may represent an important modifiable means to expand the donor pool for LTx.…”

mentioning

confidence: 99%

Aggressive pursuit and utilization of non‐ideal donor lungs does not compromise post‐lung transplant survival

Halpern

Jawitz

Raman

et al. 2021

Clinical Transplantation

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Background: Organ procurement organizations (OPOs) vary in willingness to pursue and utilize non-ideal donor lungs; implications of these practices for lung transplant (LTx) recipients remain unclear. We examined associations between OPO-level behavior toward non-ideal donors and post-LTx outcomes. Methods: Adult lung donors and corresponding adult first-time LTx recipients in the 2008-2019 UNOS registry were included. Non-ideal donors had any of age > 50, smoking history ≥20 pack-years, PaO 2 /FiO 2 ratio ≤350, donation after circulatory death, or increased risk status. OPOs were classified as least, moderately, or most aggressive based on non-ideal donor pursuit, consent attainment, lung recovery, and transplantation. Post-transplant outcomes were compared among aggressiveness strata. Results: Of 22,795 recipients, 6229 (27.3%), 8256 (36.2%), and 8310 (36.5%) received lungs from least, moderately, and most aggressive OPOs, respectively. Moderately aggressive OPOs had the highest recipient rates of pre-discharge acute rejection, grade 3 primary graft dysfunction, postoperative extracorporeal membrane oxygenation, and longest lengths of stay. After adjustment, moderately and most aggressive OPOs had similar risks of recipient mortality as least aggressive OPOs. Conclusions: The most and least aggressive OPOs achieve similar patient survival and short-term post-LTx outcomes. Aggressive pursuit and utilization of non-ideal donor lungs by less aggressive OPOs would likely expand the donor pool, without compromising recipient outcomes.

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Improving OPO performance through national data availability

Abstract: This editorial proposes a system to collect verifiable data from organ procurement organizations to be used for research, regulation, and quality improvement of the organ donation process. See the article from Cannon et al on page 2756.

Cited by 16 publications

References 8 publications

Public discourse and policy change: Absence of harm from increased oversight and transparency in OPO performance

Public discourse and policy change: Absence of harm from increased oversight and transparency in OPO performance

Rejecting bias: The case against race adjustment for OPO performance in communities of color

Aggressive pursuit and utilization of non‐ideal donor lungs does not compromise post‐lung transplant survival

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