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Performance indicators for organ donation and transplantation programmes in Europe: modified Delphi consensus study.
Simon Streit1, George Wharton2, Jasmine Mah3
1Institut für Neuropathologie, Charité Universitätsmedizin, Berlin, Germany.
The British Journal of Surgery
|January 22, 2026
Summary
A new scorecard with 84 indicators was developed to assess national organ donation and transplantation programmes. This tool aids in evaluating and improving transplant system performance and policy development.
Area of Science:
- Health policy research
- Transplantation science
- Public health indicators
Background:
- Assessing health system performance is crucial for identifying areas of improvement and guiding policy.
- While facility-level organ donation and transplantation indicators are established, national program assessment lacks consensus.
- This study aimed to create a comprehensive scorecard for evaluating national organ donation and transplantation programs.
Purpose of the Study:
- To develop a standardized, validated scorecard for assessing national organ donation and transplantation program performance.
- To establish a consensus-based set of indicators for national transplant system evaluation.
- To support evidence-informed policy development and performance benchmarking across countries.
Main Methods:
- A three-step approach involving a literature review, expert consultation, and a modified Delphi consensus process.
- 168 potential indicators were evaluated by international experts in health policy, organ donation, transplantation, and patient advocacy.
- Consensus for indicator inclusion required 80% agreement, with 24 and 22 experts participating in two rounds.
Main Results:
- A final set of 84 indicators was established across seven domains: monitoring and reporting, prevention and need, waiting lists, consent, donation, transplantation, and follow-up.
- The scorecard includes established metrics (e.g., waiting list statistics, donation rates) and novel system-level indicators (e.g., structural factors, patient-centeredness, equity).
- 103 out of 168 evaluated indicators achieved consensus for inclusion.
Conclusions:
- The validated indicator set offers a standardized tool for assessing and comparing transplant system performance.
- This scorecard facilitates performance benchmarking and supports evidence-informed policy development in organ donation and transplantation.
- The comprehensive set of indicators addresses multiple facets of national transplant programs, from donation to patient follow-up.
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