Evaluation of the stability of organ procurement organization performance metrics

Rocio Lopez ¹, Sumit Mohan ², James R Rodrigue ³

¹Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Division of Transplant Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA.
²Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; Columbia University Renal Epidemiology Group, Department of Medicine, New York.
³Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; New England Donor Services, Inc, Waltham, Massachusetts, USA.
⁴Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
⁵Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Division of Transplant Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

⁰Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Division of Transplant Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons +

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May 23, 2025

View abstract on PubMed

Summary

Organ procurement organization (OPO) performance metrics show significant variability. Refining the CALC (cause, age, location consistent with donation) criteria is crucial for stable, consistent OPO performance and maximizing organ donation.

Area Of Science

Transplantation Science
Public Health Policy
Healthcare Analytics

Background

The Centers for Medicare and Medicaid Services (CMS) updated Organ Procurement Organization (OPO) conditions for coverage in 2020.
A new metric, CALC (cause, age, location consistent with donation), was introduced to define deceased donor potential.

Purpose Of The Study

To evaluate the performance metrics of the CALC criteria.
To assess the variability and consistency of CALC performance across different data sources and adjustments.

Main Methods

Utilized 2018-2021 mortality data from the Centers for Disease Control (CDC) and Agency for Healthcare Research and Quality's State Inpatient Databases.
Analyzed yearly performance variability and compared CALC metrics between the two data sources.
Examined the impact of CALC-adjusted rates, excluding donors with contraindications.

Main Results

Significant year-to-year variability was observed in CALC performance tiers using CDC data (up to 40% of OPOs changing tiers annually).
Between 20% and 43% of OPOs changed CALC tiers when using State Inpatient Databases compared to CDC data.
11% to 29% of OPOs shifted performance tiers when using CALC-adjusted rates.

Conclusions

Current CALC performance metrics exhibit considerable variability, impacting consistency and stability.
Differences in data sources and adjustments highlight opportunities for metric refinement.
Further research is needed to optimize OPO performance measures for improved organ donation and transplant rates.

Keywords:

Centers for Medicare and Medicaid services organ procurement organization policy quality metrics transplantation

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