Importance of incorporating standardized, verifiable, objective metrics of organ procurement organization performance into discussions about organ allocation

Abstract

Identifying and supporting specific organ procurement organizations (OPOs) with the greatest opportunity to increase donation rates could significantly increase the number of organs available for transplant. Accomplishing this is complicated by current Scientific Registry of Transplant Recipients/Centers for Medicare & Medicaid Services metrics of donation rates and OPO performance that rely on eligible deaths. These data are self‐reported and unverifiable and have been shown to underestimate potential organ donors. We examine the limitations of current OPO performance/donation metrics to inform discussions related to strategies to increase donation. We propose changing to a simple, verifiable, and uniformly applied donation metric. This would allow the transplant community to (1) better understand inherent differences in donor availability based on geography and (2) identify underperforming areas that would benefit from systems improvement agreements to increase donation rates.

The cost of procuring deceased donor kidneys: Evidence from OPO cost reports 2013-2017

“…We found a correlation with the donors per 1000 deaths less than 75 years for deceased likely to be a donor candidate and the count of viable kidneys (0.30, P < .04), 11 but not with the SDRR (0.22, P < .09).…”

“…We examined OPO performance measures including the Standardized Donation Rate Ratio (SDRR) as reported for each OPO by the Scientific Registry of Transplant Recipients . Because there is controversy regarding this measure, we also examined donors per 1000 deaths of patients under 75 years of age who were likely possible donors (data limited to calendar year 2015) as a potential OPO performance measure recognizing the importance of standardized, verifiable, and objective metrics of OPO performance …”

“…These models examined the relations among selected covariates, where cost per kidney was the dependent variable. The independent variable of average number of kidneys procured was examined in linear, squared, and cubic form, after Dor et al Other covariates included percentage of nonviable kidneys, year, percentage of donors >65 years of age, measures of wait times, number of transplant programs in the OPO, and donors per 1000 deaths age less than 75 . Models adjusted for local input costs using either the COL index or the CMS Wage Index .…”

Use of Hepatitis C Nucleic Acid Test–Positive Liver Allografts in Hepatitis C Virus Seronegative Recipients

“…A majority of these donors are young and probably do not have long‐standing chronic HCV infection (based on their ages). ( 19,20 ) Such livers are already being used for transplantation into HCV NAT+ recipients. One strategy to overcome the organ shortage would be to use organs from HCV NAT+ donors for transplantation into HCV NAT– patients.…”

“…( 12,21,22 ) Transplant programs are already using organs from HCV+ donors into recipients with HCV infection. ( 19,20 ) This matched cohort study represents the largest report of HCV NAT+ livers transplanted to NAT– recipients to date in a prospective IRB–approved study. Given that HCV discordant LTs are being performed without detailed short‐term or longterm protocolled data, the importance of documented research protocol with IRB approval is necessary and important in driving the field forward.…”