The Association of Center Performance Evaluations and Kidney Transplant Volume in the United States

Schold, Jesse D.; Buccini, Laura D.; Srinivas, Titte R.; Srinivas, R.; Poggio, Emilio D.; Flechner, Stuart M.; Soria, C.; Segev, Dorry L.; Fung, John J.; Goldfarb, David A.

doi:10.1111/j.1600-6143.2012.04345.x

Cited by 110 publications

(118 citation statements)

References 27 publications

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“…Some transplant professionals have assigned blame for discards on the pressure to optimize post-transplant outcomes. 31 United States transplant centers receive report cards on quality twice a year. Every death and allograft failure after transplantation is analyzed for quality lapses and published on a publicly available website (www.srtr.org).…”

Section: Center Report Cards: a Disincentive To Use Higher-risk But Vmentioning

confidence: 99%

New Solutions to Reduce Discard of Kidneys Donated for Transplantation

Reese

Harhay

Abt³

et al. 2016

Journal of the American Society of Nephrology

122

129

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Kidney transplantation is a cost-saving treatment that extends the lives of patients with ESRD. Unfortunately, the kidney transplant waiting list has ballooned to over 100,000 Americans. Across large areas of the United States, many kidney transplant candidates spend over 5 years waiting and often die before undergoing transplantation. However, more than 2500 kidneys (.17% of the total recovered from deceased donors) were discarded in 2013, despite evidence that many of these kidneys would provide a survival benefit to wait-listed patients. Transplant leaders have focused attention on transplant center report cards as a likely cause for this discard problem, although that focus is too narrow. In this review, we examine the risks associated with accepting various categories of donated kidneys, including discarded kidneys, compared with the risk of remaining on dialysis. With the goal of improving access to kidney transplant, we describe feasible proposals to increase acceptance of currently discarded organs.

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Section: Center Report Cards: a Disincentive To Use Higher-risk But Vmentioning

confidence: 99%

New Solutions to Reduce Discard of Kidneys Donated for Transplantation

Reese

Harhay

Abt³

et al. 2016

Journal of the American Society of Nephrology

122

129

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“…Nevertheless, the perception of many transplant programs is that risky transplants and innovations can cause program outcomes to appear worse and result in lost contracts and referrals (15). Thus, programs with worse outcomes reduce the numbers of transplants they perform and preferentially avoid accepting high-risk recipients and donors (16,17). This is not necessarily bad if these transplants are performed by other programs and overall access to transplant remains unaffected.…”

Section: Discussionmentioning

confidence: 99%

Potential Implications of Recent and Proposed Changes in the Regulatory Oversight of Solid Organ Transplantation in the United States

Kasiske

Salkowski

Wey

et al. 2016

American Journal of Transplantation

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Every 6 months, the Scientific Registry of Transplant Recipients (SRTR) publishes evaluations of every solid organ transplant program in the United States, including evaluations of 1‐year patient and graft survival. The Centers for Medicare & Medicaid Services (CMS) and the Organ Procurement and Transplantation Network (OPTN) Membership and Professional Standards Committee (MPSC) use SRTR's 1‐year evaluations for regulatory review of transplant programs. Concern has been growing that the regulatory scrutiny of transplant programs with lower‐than‐expected outcomes is harmful, causing programs to undertake fewer high‐risk transplants and leading to unnecessary organ discards. As a result, CMS raised its threshold for a “Condition‐Level Deficiency” designation of observed relative to expected 1‐year graft or patient survival from 1.50 to 1.85. Exceeding this threshold in the current SRTR outcomes report and in one of the four previous reports leads to scrutiny that may result in loss of Medicare funding. For its part, OPTN is reviewing a proposal from the MPSC to also change its performance criteria thresholds for program review, to review programs with “substantive clinical differences.” We review the details and implications of these changes in transplant program oversight.

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“…CMS promulgated these rules for transplant center certification in the name of advancing patient safety and improving transplant outcomes [7,8]. However, since implementation of the CoPs, some experts have questioned whether these rules have improved outcomes or simply resulted in restricted access for higher-risk patients and reduced innovation [9][10][11][12].…”

Section: The Transplant Environment Under the Medicare Conditions Of mentioning

confidence: 99%

“…However, there is also clear evidence that failure to meet the publicly reported outcome standards can have a devastating impact on transplant programs [9,15]. Not surprisingly, when centers receive low performance evaluations, they perform fewer transplants and reduce the size of their waitlists for both kidney [12] and liver [16] transplantation. Centers cited for poor outcomes often see dramatic reductions in referrals [17], resulting in fewer new listings for transplant and substantial losses of clinical volume and hospital revenue.…”

Section: The Transplant Environment Under the Medicare Conditions Of mentioning

confidence: 99%

Regulations' Impact on Donor and Recipient Selection for Liver Transplantation: How Should Outcomes be Measured and MELD Exception Scores be Considered?

Adler¹,

Axelrod²

2016

AMA Journal of Ethics

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The Association of Center Performance Evaluations and Kidney Transplant Volume in the United States

Cited by 110 publications

References 27 publications

New Solutions to Reduce Discard of Kidneys Donated for Transplantation

New Solutions to Reduce Discard of Kidneys Donated for Transplantation

Potential Implications of Recent and Proposed Changes in the Regulatory Oversight of Solid Organ Transplantation in the United States

Regulations' Impact on Donor and Recipient Selection for Liver Transplantation: How Should Outcomes be Measured and MELD Exception Scores be Considered?

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