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Am J Transplant. 2017 Dec;17(12):3183-3192. doi: 10.1111/ajt.14391. Epub 2017 Jul 20.

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

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Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.
Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
The Bridgespan Group, New York, NY.
The Bridgespan Group, Boston, MA.
Organize, New York, NY.
Former Acting Surgeon General of the United States, Great Falls, MT.
Gift of Life Institute, Philadelphia, PA.
Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA.


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 geographic-level 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.


clinical research/practice; donors and donation; donors and donation: deceased; ethics and public policy; law/legislation; organ procurement; organ procurement and allocation; organ procurement organization

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