Population Characteristics and Organ Procurement Organization Performance Metrics

Area of Science:

• Organ transplantation and procurement
• Public health policy
• Health services research

Background:

• Centers for Medicare & Medicaid Services (CMS) updated Organ Procurement Organization (OPO) Conditions for Coverage in 2020.
• Current OPO performance evaluation uses unadjusted donation and age-adjusted transplant rates, neglecting population differences.
• The Cause, Age, and Location Consistent (CALC) tiering system requires further examination for its effectiveness.

Purpose of the Study:

• To determine if adjusting for age and area deprivation index (ADI) changes OPO tier assignments compared to the CMS CALC tier.
• To assess the impact of population characteristics on OPO performance metrics.

Main Methods:

• Retrospective cross-sectional study of 58 OPOs from 2018-2020.
• Analysis of 12,041,778 death records and 42,572 solid organ donors.
• Statistical analysis performed from January 2017 to December 2020, examining age and ADI of potential donors.

Main Results:

• Age and ADI adjustments led to reclassification of tier ratings for 19.0% to 31.0% of OPOs.
• 46.6% of OPOs experienced at least one tier change over the 3-year period.
• Between 6.9% and 12.1% of OPOs moved to tier 1, and up to 8.6% moved to tier 3.

Conclusions:

• Adjusting for area deprivation and age significantly alters measured OPO performance and tier classifications.
• Underlying population characteristics may independently affect donation and transplant rates, independent of OPO performance.
• Risk adjustment for population characteristics should be considered in future OPO policy and quality metric evaluations.