Boston, MA, October 30, 1998. No one questions that there is a severe shortage of organs for transplantation. Nearly 60,000 Americans currently are waiting for organ transplants, and ten or more die every day because an organ does not become available in time. Many people believe the answer lies in increasing public awareness of the need for organs. But an article in the November issue of the American Journal of Public Health points to a bigger problem: the donation community has little idea how well or poorly it is doing in collecting available organs.
"A major impediment to increasing donation is the lack of a reliable and valid method to assess current donor potential and organ procurement performance at regional and national levels," says principal author Cindy L. Christiansen, PhD, assistant professor of ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care. The current standards for organ procurement organization (OPO) effectiveness rely on a donors-per-million-population measure, assuming uniformity across the United States, but such an assumption has never been systematically tested. A better measure would relate actual donors to potential donors.
In the past, the only reliable method to obtain this information was to conduct detailed reviews of medical records in every hospital, a procedure that is highly resource-intensive if performed in the over 6000 US hospitals where donation could occur. The organ donation field has long needed a simpler and more economical method to obtain estimates of donor potential in geographic regions.
This study, conducted by the Harvard Medical School, the Harvard School of Public Health, The Partnership for Organ Donation, the California Transplant Donor Network (San Francisco, CA), LifeSource Upper Midwest Organ Procurement Organization (Minneapolis, MN), and the Washington Regional Transplant Consortium (Falls Church, VA), recognizes that OPO regions are defined by the hospitals they contain. Readily available information about hospital characteristics in a region can be used to generate valid estimates of organ donor potential for that region.
Data from medical records review for calendar year 1993 were collected in a stratified random sample of 89 large, medium, and small hospitals. A total of 594 potential organ donors were identified in the sample of which only 215 or 36% actually became donors. Potential donors were concentrated in the largest hospitals, yet large hospitals as a group realized only 39% of their potential donors. Among hospitals with 10 or more potential donors, donation rates ranged from 7% to 58%.
Using the results from medical records reviews to test a range of predictor variables, the authors show that it is possible to generate accurate estimates of donor potential in a geographic region based on five key hospital variables: number of deaths, number of staffed beds, Medicare case-mix index, medical school affiliation, and trauma center designation.
"A major application of this model is to provide a realistic baseline against which OPOs and policy makers can assess donation performance and target areas for improvement. Given the size of the gap between current performance and estimated potential, even a conservative estimate can be highly useful to OPOs in setting goals," says Christiansen. "Such information can be valuable at the national and regional levels to assist in developing goals for organ donation, benchmarking procurement effectiveness, and tracking changes in underlying donor potential."
"With a better understanding of donor potential and donor results, we can allocate resources appropriately to those regions with largest numbers of unrealized potential organ donors," says Carol Beasley, Managing Director of The Partnership for Organ Donation. "Similarly, those regions with very high donation effectiveness may have lessons that can be applied to lower-donation areas. Having a valid measure of donation performance will greatly enhance the efforts of the many organizations working to save more lives through organ donation and transplantation."
This study was supported by a grant from the United States Department of Health and Human Services, Public Health Service, Health Resources and Services Administration, Department of Organ Transplantation.
Contact: Bill Schaller Harvard Medical School 617-432-0441 Carol Beasley The Partnership for Organ Donation 617-482-5746
Journal
American Journal of Public Health