To Increase Organs Available for Transplantation, Reassess Organ Procurement Organizations’ Metrics

A new paper analyzes the metrics used to evaluate organ procurement organizations and proposes three complimentary metrics to reflect more accurate and equitable performance rankings.

10:58 AM

Author | Kylie Urban

black ink illustration of hand holding heart
Getty Images

Organ procurement organizations are a critical component in organ transplantation in the United States. But, what makes an organ procurement organization high performing and obtaining much needed organs to those awaiting a transplantation?

In a new paper, published in JAMA Surgery, researchers found the metrics used to rank organ procurement organizations don't create an even playing field for organizations, and lead to inaccuracies.

"The 58 organ procurement organizations throughout the U.S. coordinate placing organs from deceased donors with recipients," says Neehar Parikh, M.D., senior author of the paper and an assistant professor in the divisions of gastroenterology and hepatology at Michigan Medicine. "The organizations are evaluated by their efficiency in procuring organs and getting them to recipients by a variety of metrics, including eligible donors, donor demographics, donors per death and more."

Analyzing metrics

Parikh says the research team analyzed national organ transplant data from 2008 to 2017 and found a wide variation in organ procurement organizations' efficiency.

"High performing sites were pretty variable depending on which metric you chose," Parikh says. "Donors that do not meet eligibility criteria explained a large part of this variance. There was also variance in donation by race and ethnicity, which highlights the disparities in donation that may be due to lack of consent or other biases that may underutilize these organs."

The team proposed a combination of three metrics that would give a more accurate and equitable representation of organ procurement organization performance.

"The three metrics we are suggesting are donors per death, eligible donors per eligible death and eligible donors per donor, or the donor eligibility rate," says Luke DeRoos, lead author of the study and a Ph.D. student in the University of Michigan College of Engineering.

The researchers defined donors per death as the percentage of the population that donates an organ when deceased, while eligible donors per eligible death is a similar rate that only considers individuals that meet a list of broad health criteria.

"Since many organ transplants successfully use 'ineligible' donors outside of these health criteria, the donors per death and eligible donors per eligible death metrics can appear very different," DeRoos says.

The research team also noted that transplant centers use ineligible donors at vastly different rates, as demonstrated in the donor eligibility rate, which measures the percentage of donors that meet all health criteria. The researchers say this rate can highlight which centers have consistently identified traditionally ineligible donors as good candidates for donation, which could lead to best practice sharing.

"By using a consistent definition of eligibility and comparing these metrics against each other, you gain more advanced insight into how eligibility definition greatly impacts the procurement organizations' overall ratings," DeRoos says.

Parikh adds, "These complimentary metrics would give a better picture of how the organizations are performing, and could allow for quality improvement with the goal of increasing the number of organs available for transplantation."

Future evaluation of organ donation system

The research team hopes this study will help with overall evaluations of the national organ donation system.

"We have a collaborative research group with the U-M College of Engineering and the U-M School of Public Health that is interested in exploring the national organ donation system and ways to improve it," Parikh says.

The Centers for Medicare & Medicaid Services announced new organ procurement metrics in November 2020. They will now use the number of transplanted organs from an organ procurement organizations' donor service area as a percentage of inpatient deaths among patients 75 years old or younger, and with a primary cause of death that is consistent with organ donation.

"There have been efforts by the federal government to evaluate and overhaul the organ donation system, as evidenced by the recently announced change in the way organ procurement organizations will be evaluated," Parikh says. "Our findings give a snapshot in the variance in performance depending on which metrics you choose."

Paper cited/DOI: "Assessment of National Organ Donation Rates and Organ Procurement Organization Metrics," JAMA SurgeryDOI:10.1001/jamasurg.2020.5395

More Articles About: Industry DX Demographics Health Care Delivery, Policy, and Economics Transplant Surgery Hospitals & Centers Transplant
Health Lab word mark overlaying blue cells
Health Lab

This article is from the Health Lab digital publication.

Media Contact Public Relations

Department of Communication at Michigan Medicine



Get a weekly digest of medical research and innovation, straight to your inbox.

Featured News & Stories pediatrician talking with mother at exam questions
Health Lab
Checklist for the checkup: Some parents may not be making the most of well child visits
While many parents keep recommended well visits with their child’s primary provider, some may consider more proactive steps to make checkups as productive as possible
scientist examining a kidney
Health Lab
An AI model predicting acute kidney injury works, but not without some tweaking
The model identified AKI 48 hours in advance, allowing ample time for clinicians to intervene and provide treatment.
woman doctor scrubs sad ashamed lab note
Health Lab
Study in residents shows high prevalence of sexual harassment, yet low reporting rates
Research reveals that one in four women among internal medicine residents experiences sexual harassment, but far fewer go on to report it.
Watercolor Painting People Rain Umbrella
Health Lab
Support from others in stressful times can ease impact of genetic depression risk
Stress can interact with genetic vulnerability to depression, and with added or lacking support from friends and family, to affect depressive symptoms.
eye drawing lab note
Health Lab
Many older adults lack clear eyesight, even with glasses
Vision impairment disproportionately impacts older adults
VAD heart device cooler red and teal
Health Lab
Medicare policy change could increase inequity in heart transplant access, study finds
Patients seen at transplant centers had almost 80% higher odds to receive “bridge-to-transplant” designation