Development of an improved Scientific Registry of Transplant Recipients deceased donor heart yield model using donor critical care data from the Donor Management Goal Registry cohort.

Organ procurement organizations (OPOs) face increasing regulatory scrutiny, and the performance of predictive models used to assess OPO performance is critical. We sought to determine whether adding deceased donor physiological and critical care data to the existing Scientific Registry of Transplant Recipients (SRTR) heart yield model would improve the model's performance. Donor data and heart transplanted (yes/no), the outcome of interest, were obtained from the United Network for Organ Sharing Donor Management Goal (DMG) Registry for 19 141 donors after brain death, from 25 OPOs. The data were split into training and testing portions. Multivariable LASSO regression was used to develop a statistical model incorporating DMG data elements with the existing components of the SRTR model. The DMG + SRTR and SRTR models were applied to the test data to compare the predictive performance of the models. The sensitivity (84%-86%) and specificity (84%-86%) were higher for the DMG + SRTR model compared to the SRTR model (71%-75% and 76%-77%, respectively). For the DMG + SRTR model, the C-statistic was 0.92 to 0.93 compared to 0.80 to 0.81 for the SRTR model. DMG data elements improve the predictive performance of the heart yield model. The addition of DMG data elements to the Organ Procurement and Transplantation Network data collection requirements should be considered.

Engaging the third estate: the Transplant Growth and Management Collaborative.

The Organ Donation and Transplantation Collaboratives that occurred within the United States from 2004 to 2008 helped contribute to a significant increase in organ donors and transplants across the country. Centers were needed to accommodate and maintain this increase in capacity to perform successful transplantations for candidates on the waiting list. The Transplant Growth and Management Collaborative was created to help fulfill this new performance level expectation. In 2007 the US Department of Health and Human Services, Health Resources and Services Administration published a best-practice report based on high-performing centers that experienced a significant increase in volume while maintaining expected, or higher than expected, outcomes. The report produced a change package that outlined common strategies, key change concepts, and actions used at the best-practice centers that could be adapted by other transplant programs by using Plan-Do-Study-Act cycles to test the impact of the changes. This change package and use of the Plan-Do-Study-Act cycles formed the foundation of the Collaborative that occurred from October 2007 through October 2008 to spread best practices to transplant programs willing to commit to making changes that could result in a 20% increase in transplant volume. More than 120 transplant centers participated at some point in the Collaborative. Although preliminary results of the Collaborative show that only a few participating programs achieved the 20% volume increase goal, many participating centers reported putting successful models in place for each of the strategies identified in the best-practice change package.

US organ donation breakthrough collaborative increases organ donation.

More than 92000 Americans are on waiting lists for organ transplants, and an average of 17 of them die each day while waiting. The US Organ Donation Breakthrough Collaborative (ODBC), which began in 2003 at the request of the Secretary of the US Department of Health and Human Services, was a formal, concerted effort of the donation and transplantation community to bring about a major change to improve the organ donation system. The nationwide Collaborative was housed within a Health and Human Services agency, the Health Resources and Services Administration (HRSA) Division of Transplantation, and included participation of the organ procurement organizations (OPOs) throughout the United States and the American hospitals with the largest organ-donor potential. HRSA leaders used the Breakthrough Series Collaborative method, originally developed by the Institute for Healthcare Improvement, as the model for the intervention. Expert practitioners drawn from hospitals and OPOs that had already demonstrated their ability to achieve and sustain high organ donation rates were chosen as faculty for the collaborative and best practices were gleaned from their institutions. The number of organ donors in Collaborative hospitals increased 14.1% in the first year, a 70% greater increase than the 8.3% increase experienced by non-Collaborative hospitals. Moreover, the increased organ recovery continued into the post-Collaborative periods. Between October 2003 and September 2006, the number of total US organ donors increased 22.5%, an increase 4-fold greater than the 5.5% increase measured over the same number of years in the immediate pre-Collaborative period. The study did not involve a randomized design, but time-series analysis using statistical process control charts shows a highly significant discontinuity in the rate of increase in participating hospitals concurrent with the Collaborative program, and strongly suggests that the activities of the Collaborative were a major contributor to this increase. Given the stable nature of the historical increases over many years, the HRSA estimates that more than 4000 annual additional transplants have occurred in association and apparently as a result of these increases in organ donation.

Does quality improvement work? Evaluation of the Organ Donation Breakthrough Collaborative.

OBJECTIVE: The Organ Donation Breakthrough Collaborative is a quality improvement initiative to encourage adoption of "best practices" for identifying potential donors and obtaining consent for deceased organ donation. We evaluate the impact of the first phase on organ donation rates. SETTING: We study donation rates in the 95 hospitals that participated in the first phase and a control group of 125 hospitals. DESIGN: We use a controlled pre/post design. The preperiod is the year before the start of the Collaborative (September 2002 to August 2003), the postperiod is the final 6 months of the first phase (March 2004 to August 2004). DATA: We use administrative data from the Organ Procurement and Transplantation Network to compute the conversion rate in each hospital group and time period. The conversion rate is the proportion of eligible donors who became actual donors. PRINCIPAL FINDINGS: Preperiod conversion rates in Collaborative and control hospitals were similar: 52 and 51 percent, respectively. In the postperiod, the conversion rate increased to 60 percent among Collaborative hospitals and remained at 51 percent among control hospitals. The relative change was 8 percentage points (95 percent confidence interval: 2-13: p<.001). CONCLUSIONS: Our findings suggest that the Breakthrough Collaborative led to an increase in donation rates at participating hospitals.