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Published on: August 2, 2019
Pediatric donor heart utilization variability among organ procurement organizations
Firezer Haregu1, R Jerome Dixon2, Michael Porter3
1Pediatric Cardiology, University of Virginia Children's Hospital, Charlottesville, Virginia, USA.
Insights
Pediatric donor heart utilization varies by organ procurement organization (OPO), but OPO management isn't the cause. Listing center practices and prior offer refusals significantly impact heart acceptance, explaining utilization disparities.
Area of Science:
- Pediatric transplantation
- Organ procurement and utilization
Background:
- Organ procurement organizations (OPOs) manage organ donors, but pediatric donor heart utilization varies significantly.
- Understanding factors influencing this variability is crucial for improving pediatric heart transplant access.
Purpose of the Study:
- To investigate the reasons behind the observed variability in pediatric donor heart utilization rates among different OPOs.
- To identify key factors influencing the acceptance of pediatric donor heart offers.
Main Methods:
- Analysis of the Organ Procurement and Transplant Network database (2010-2019) for pediatric heart donors and recipients.
- Stratification of OPOs by utilization rates and comparison of top/bottom quintiles.
- Application of a machine learning algorithm to identify predictive factors for heart offer acceptance.
Main Results:
- No significant differences found in donor characteristics, management, or organ quality between high and low utilization OPOs.
- Machine learning identified prior donor offer refusals and listing center acceptance practices as primary drivers of organ acceptance.
- Neither OPO donor management nor cardiac function alone determined organ acceptance.
Conclusions:
- Variations in OPO clinical practices do not appear to explain disparities in pediatric donor heart utilization.
- Listing center acceptance behavior and the number of previous offer rejections are critical factors influencing heart utilization.
- These factors may partially account for observed OPO utilization rate variations due to regional OPO-listing center associations.
Background:
Organ procurement organizations (OPOs) are responsible for the medical management of organ donors. Given the variability in pediatric donor heart utilization among OPOs, we examined factors that may explain this variability, including differences in donor medical management, organ quality, and candidate factors.
Methods:
The Organ Procurement and Transplant Network database was queried for pediatric (<18 years) heart donors and candidates receiving pediatric donor heart offers from 2010 to 2019. OPOs were stratified by pediatric donor heart utilization rate, and the top and bottom quintiles were compared based on donor management strategies and outcomes. A machine learning algorithm, combining 11 OPO, donor, candidate, and offer variables, was used to determine factors most predictive of whether a heart offer is accepted.
Results:
There was no clinically significant difference between the top and bottom quintile OPOs in baseline donor characteristics, distance between donor and listing center, management strategies, or organ quality. Machine learning modeling suggested neither OPO donor management nor cardiac function is the primary driver of whether an organ is accepted. Instead, number of prior donor offer refusals and individual listing center receiving the offer were two of the most predictive variables of organ acceptance.
Conclusions:
OPO clinical practice variation does not seem to account for the discrepancy in pediatric donor heart utilization rates among OPOs. Listing center acceptance practice and prior number of donor refusals seem to be the important drivers of heart utilization and may at least partially account for the variation in OPO heart utilization rates given the regional association between OPOs and listing centers.
