Investigating Geographic Variation in Mortality in the Context of Organ Donation

Sheehy, Ellen; OʼConnor, Kevin; Luskin, Richard S.; Howard, Richard J.; Cornell, Danielle L.; Finn, Jan; Mone, Thomas; Selck, F. W.; Delmonico, Francis L.

doi:10.1111/j.1600-6143.2011.03981.x

Cited by 35 publications

(36 citation statements)

References 15 publications

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“…We employed several assumptions to develop our estimate of the possible donor supply, albeit based on published data that could be extrapolated to our population of patients dying in an intensive care unit potentially eligible to be a deceased donor. We estimated an average of 13 985 possible DNDD donors, which we feel confident is close to the true donor potential for two reasons: (1) the estimates of the possible donor supply obtained using administrative data matched closely with patient-level data obtained from chart review from two OPOs; and (2) a large multiyear study that utilized medical record review of patients in 434 hospitals across 36 OPOs between 1997 and 1999 suggested the DNDD donor potential may be as high as 13 800 per year (29)(30)(31). Given increases in the number of deaths that could lead to donation (i.e.…”

Section: Discussionmentioning

confidence: 70%

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

Goldberg

Kallan

et al. 2017

American Journal of Transplantation

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The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographiclevel donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.Abbreviations: AHRQ-NIS, agency for healthcare research and quality-nationwide inpatient sample; DCDD, donation after circulatory determination of death; DNDD, donation after neurologic determination of death; DSA, donor service area; EDCR, eligible death conversion rate; HCUP, healthcare cost and utilization project; HRSA, health resources and services administration; OPO, organ procurement organization; OTPPD, organs transplanted per possible donor; SIDs, state inpatient databases; UNOS, united network for organ sharing

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Section: Discussionmentioning

confidence: 70%

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

Goldberg

Kallan

et al. 2017

American Journal of Transplantation

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“…7,8 By this logic, using eligible deaths as a denominator to which overall donor yield is compared is a fair measure of OPO performance, as it accounts for these population differences over which an OPO has no control. 7,8 By this logic, using eligible deaths as a denominator to which overall donor yield is compared is a fair measure of OPO performance, as it accounts for these population differences over which an OPO has no control.…”

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

confidence: 99%

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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“…Allocation Given the reality in which the availability of organs is such that there will always be scarcity (even if everyone who could donate upon death did so, which is only 0.5 % of all deaths (Sheehy et al 2012)), it is essential to ensure that all of those who can donate do so. To accomplish this it is essential that all who may be asked to donate believe that if they need a transplant they will have an equal opportunity to receive one.…”

Section: Separation From Transplantationmentioning

confidence: 99%

“…And while perfect-match kidneys may travel across the country and the sickest liver recipient in a broader region may receive the next organ, local-first remains the basis of organ sharing (Graham 2006). A problematic consequence of this historic allocation sys-tem is that potential organ donors are not uniformly distributed across the US, with the some regions having 40-50 % higher potential and concordant 40-50 % shorter waiting times for transplant (Sheehy et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Organ Transplantation in Times of Donor Shortage

Jox¹,

Assadi²,

Marckmann³

2016

International Library of Ethics, Law, and the New Medicine

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The book series International Library of Ethics, Law and the New Medicine comprises volumes with an international and interdisciplinary focus. The aim of the Series is to publish books on foundational issues in (bio) ethics, law, international health care and medicine. The 28 volumes that have already appeared in this series address aspects of aging, mental health, AIDS, preventive medicine, bioethics and many other current topics.This Series was conceived against the background of increasing globalization and interdependency of the world's cultures and governments, with mutual influencing occurring throughout the world in all fields, most surely in health care and its delivery. By means of this Series we aim to contribute and cooperate to meet the challenge of our time: how to aim human technology to good human ends, how to deal with changed values in the areas of religion, society, culture and the self-definition of human persons, and how to formulate a new way of thinking, a new ethic.We welcome book proposals representing the broad interest of the interdisciplinary and international focus of the series. We especially welcome proposals that address aspects of 'new medicine', meaning advances in research and clinical health care, with an emphasis on those interventions and alterations that force us to reexamine foundational issues.More information about this series at

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Investigating Geographic Variation in Mortality in the Context of Organ Donation

Cited by 35 publications

References 15 publications

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

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

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

Organ Transplantation in Times of Donor Shortage

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