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          Original Investigation
          December?2, 2020

          Assessment of National Organ Donation Rates and Organ Procurement Organization Metrics

          Author Affiliations
          • 1Industrial and Operations Engineering, University of Michigan, Ann Arbor
          • 2Electrical Engineering and Computer Science, University of Michigan, Ann Arbor
          • 3Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
          • 4Department of Surgery, University of Michigan, Ann Arbor
          • 5School of Public Health, University of Michigan, Ann Arbor
          JAMA Surg. Published online December 2, 2020. doi:10.1001/jamasurg.2020.5395
          Key Points

          Question? Do current donation metrics adequately represent organ procurement organization (OPO) performance?

          Findings? In this national study of 75?769 organ donors, OPO performance varied significantly over time and across donation metrics, which were not entirely described by population demographics. The performance of OPOs was positively associated with use of donors who were ineligible, which varied significantly among OPOs and demographic subgroups.

          Meaning? Use of donors who are ineligible should be considered within OPO performance metrics to provide a more accurate assessment of performance, and this represents a target metric for improving organ availability.

          Abstract

          Importance? Organ transplant is a life-saving procedure for patients with end-stage organ failure. In the US, organ procurement organizations (OPOs) are responsible for the evaluation and procurement of organs from donors who have died; however, there is controversy regarding what measures should be used to evaluate their performance.

          Objective? To evaluate OPO performance metrics using combined mortality and donation data and quantify the associations of population demographics with donation metrics.

          Design, Setting, and Participants? This national cohort study includes data from the US organ transplantation system from January 2008 through December 2017. All individuals who died within the US, as reported by the National Death index, were included.

          Exposures? Death, organ donation, and donation eligibility.

          Main Outcomes and Measures? Evaluation of the variation in donation metrics and the use of ineligible donors by OPO and demographic subgroup.

          Results? This study included 17?501?742 deaths and 75?769 deceased organ donors (45?040 men [59.4%]; 51?908 White individuals [68.5%]). Of these donors, 15?857 (20.9%) were not eligible, as defined by the OPOs. The median donation metrics by OPO were 0.004 (range, 0.002-0.012) donors per death, 0.89 (range, 0.68-1.30) donors per eligible death, and 0.72 (range, 0.57-0.86) eligible donors per eligible death. The OPOs in the upper quartile of the overall eligible donors per eligible death metric were in the upper quartile of annual rankings on 90 of 140 occasions (64.3%). There was little overlap in top-performing OPOs between metrics; an OPO in the upper quartile for 1 metric was also in the upper quartile for the other metrics on 37 of 570 occasions (6.5% of the time). The median donor eligibility rate, defined as the number of eligible donors per donor, was 0.79 (range, 0.61-0.95) across OPOs. Age (eg, 65 to 84 years, coefficient, ?0.55 [SE, 0.03]; P?<?.001; vs those aged 18 to 34 years), sex (male individuals, ?0.09 [SE, 0.02]; P?<?.001; vs female individuals), race (eg, Black individuals, 0.35 [SE, 0.02]; P?<?.001; vs White individuals), cause of death (eg, central nervous system tumor, 0.48 [SE, 0.08]; P?<?.001; vs anoxia), year (eg, 2016-2017: ?0.10 [SE, 0.03]; P?<?.001; vs 2008-2009), and OPO were associated with the use of ineligible donors; OPO was a significant factor associated with performance in all metrics (χ256, 500.5; P?<?.001; coefficient range across individual OPOs, ?0.15 [SE, 0.09] to 0.75 [SE, 0.09]), even after accounting for population differences. Female and non-White individuals were significantly less likely to be used as ineligible donors.

          Conclusions and Relevance? We demonstrate significant variability in OPO performance rankings, depending on which donation metric is used. There were significant differences in OPO performance, even after accounting for differences in potential donor populations. Our data suggest significant variation in use of ineligible donors among OPOs, a source for increased donors. The performance of OPOs should be evaluated using a range of donation metrics.

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