OPTN/SRTR 2019 Annual Data Report: Deceased Organ Donors.

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2019, there were 11,870 deceased donors, an increase from 10,721 in 2018; this number has been increasing since 2010. The number of deceased donor transplants increased to 32,313 in 2019, from 29,675 in 2018; this number has been increasing since 2012. The increase may be due in part to the rising number of deaths of young people due to the ongoing opioid epidemic. The number of organs transplanted included 17,425 kidneys, 1,018 pancreata, 8,275 livers, 81 intestines, 3,604 hearts, and 2,607 lungs. In 2019, 4,324 kidneys, 346 pancreata, 867 livers, 5 intestines, 31 hearts, and 148 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards.

OPTN/SRTR 2018 Annual Data Report: Deceased Organ Donation.

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2018, there were 10,721 deceased donors, and this number has been increasing since 2010. The number of deceased donor transplants increased to 29,676 in 2018 from 28,582 in 2017, and this number has been increasing since 2012. The recent increase may be due in part to the rising number of deaths of young people due to the opioid epidemic. In 2018, 4994 organs were discarded, slightly more than 4813 in 2017. In 2018, 3755 kidneys, 278 pancreata, 707 livers, 3 intestines, 23 hearts, and 317 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards.

OPTN/SRTR 2017 Annual Data Report: Deceased Organ Donation.

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2017, 1,085,646 death and imminent death referrals were made to organ procurement organizations, of which 22,265 met the definition of eligible (11,673) or imminent neurological (10,592) deaths per OPTN policy. There were 10,286 deceased donors, and this number has been increasing since 2010. The number of organs authorized for recovery has also continued to increase since 2010. The recent increase may be in part due to the rising number of deaths of young individuals due to the opioid epidemic. In 2017, 4813 organs were discarded, including 3542 kidneys, 309 pancreata, 742 livers, 4 intestines, 33 hearts, and 272 lungs. These numbers suggest a need to reduce the number of organs discarded.

OPTN/SRTR 2016 Annual Data Report: Deceased Organ Donation.

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2016, 1,072,717 death and imminent death referrals were made to organ procurement organizations, of which 23,433 met the definition of eligible (10,717) or imminent (12,716) deaths per OPTN policy. There were 9971 deceased donors, and this number has been increasing since 2010. The number of organs authorized for recovery has also continued to increase since 2010. In 2016, 4859 organs were discarded, including 3631 kidneys, 317 pancreata, 739 livers, 8 intestines, 31 hearts, and 211 lungs. These numbers suggest a need to reduce the number of organs discarded.

OPTN/SRTR 2015 Annual Data Report: Deceased Organ Donation.

SRTR uses data collected by OPTN to calculate metrics such as donation/conversion rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2015, 1,072,828 death and imminent death referrals were made to Organ Procurement Organizations, of which 21,559 met the definition of eligible (9793) or imminent (11,766) deaths per OPTN policy. The number of deceased donors was 9080, and this number has been increasing since 2010. The number of organs authorized for recovery increased slightly to 65,086 in 2015, and the number recovered increased slightly to 25,762. In 2015, 4370 organs were discarded, including 3157 kidneys, 311 pancreata, 703 livers, 30 hearts, and 214 lungs. These numbers suggest a need to reduce the number of organs discarded.

Deceased Organ Donation.

SRTR uses data collected by OPTN to calculate metrics such as donation/conversion rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2014, 9252 eligible deaths were reported by organ procurement organizations, a slight increase from 8944 in 2012, and the donation/conversation rate was 73.4 eligible donors per 100 eligible deaths, a slight increase from 71.3 in 2013. Some metrics show variation across organ procurement organizations, suggesting that sharing best practices could lead to gains in efficiency and organ retrieval.

OPTN/SRTR 2013 Annual Data Report: deceased organ donation.

The status of deceased organ donation is assessed using metrics such as donation/conversation rate, organ yield, and rate of organs recovered for transplant and not transplanted. These metrics are based on eligible deaths (brain death of a person aged 70 years or younger) as well as on actual donors. The 9132 eligible deaths reported in 2013 represented a slight increase over 2012. The donation/conversion rate was 71.3 eligible donors per 100 eligible deaths, a slight decline from 2012, and varied by donation service area from 50.0 to 87.0. The number of organs recovered per donor, 3.55, also varied by donation service area, from 2.79 to 4.10. The mean number of organs transplanted per donor was 3.08 in 2013, slightly higher than 3.02 in 2012. The mean observed/expected organ yield ratio for kidneys varied from 0.86 to 1.18; for pancreata, from 0.29 to 2.59; for livers, from 0.69 to 1.17; for hearts, from 0.68 to 1.41; and for lungs, from 0.33 to 1.41. The rate of organs recovered for transplant and not transplanted in 2013 for all organs combined was 0.13 per recovered organ, slightly lower than the rate of 0.14 in 2012.

OPTN/SRTR 2012 Annual Data Report: deceased organ donation.

The status of deceased organ donation is assessed using several metrics, including donation/conversion rate (how often at least one organ is recovered for transplant from an eligible death), organ yield (ratio of observed/expected numbers of organs transplanted), and rate of organs discarded (number of organs discarded divided by the number of organs recovered for transplant). The 2012 donation/conversion rate was 72.5. eligible donors per 100 eligible deaths, slightly lower than the 2011 rate but higher than in previous years. The 2011-2012 yield ratio varied by donation service area from 0.91 (fewer organs transplanted per donor than expected) to 1.09 (more than expected), and also varied for specific organs. The mean number of organs transplanted per donor in 2012 was 3.02, lower than in 2011 and 2010; this number varied by donation service area from 2.04 to 3.76. The number of organs discarded is calculated by subtracting the number of organs transplanted from the number recovered for transplant; this number is used to calculate the discard rate. The discard rate in 2012 for all organs combined was 0.14 per recovered organ, slightly higher than in 2011 and 2011; it varied by donation service area and organ type.

OPTN/SRTR 2011 Annual Data Report: deceased organ donation.

In 2011, the number of eligible deaths (death of a patient aged 70 years or younger who is legally declared brain dead and does not exhibit any excluding factors) was 9023, a slight decrease from 2010; 72.9 eligible donors per 100 eligible deaths were converted to organ donors. The unadjusted donation rate varied by donation service area (DSA), as did the number of transplant programs. The observed/expected organ yield ratio for all organs varied by DSA from 0.89 to 1.13. The total number of organs recovered divided by the number of donors was 3.54, slightly lower than in 2010; this value varied by DSA from 2.91 to 4.19. The number of organs transplanted per donor was 3.07, varying by DSA from 2.28 to 3.37. The discard rate for all organs combined was 0.13 per recovered organ, a value that varied substantially by DSA and by organ type. Reasons for not procuring or for discarding organs varied by organ type. Numbers of intestines, hearts, and lungs procured for transplant but not used are smaller than numbers of kidneys, pancreata, and livers because intestines, hearts, and lungs are recovered only after a transplant center has accepted the organ for transplant.

Optimizing recovery, utilization and transplantation outcomes for kidneys from small, ≤20 kg, pediatric donors.

The optimal balance between maximizing the number versus the outcome of transplantation utilizing kidneys from small (≤20 kg) pediatric donors remains unclear, complicated by the choice of single versus en bloc transplantation with their attendant technical risks. Using the Organ Procurement and Transplantation Network (OPTN) database, we examined kidney recovery and utilization patterns, and 1-year transplant outcomes by single kilogram weight strata. Between January 1, 2005 and June 30, 2010, 2352 kidneys from ≤20 kg donors were transplanted into 1531 recipients, 710 single kidney transplants (SKTs) and 821 en bloc kidney transplants (EBKTs). Increased donor weight was associated with higher rates of recovery, transplantation and SKT. Low donor weight (linear p < 0.001; quadratic p = 0.003), SKT versus EBKT (p = 0.008), increased cold ischemia time (p = 0.003), local versus nonlocal donor (p = 0.0044), low versus high volume center (p = 0.003) and the interaction term between center volume and donor weight (p = 0.0024) were associated with graft failure. Notably, lower donor weight exacerbated the negative impact of low center volume but did not worsen the negative impact of SKT on outcomes. Our data show that EBKT offers superior 1-year survival at the expense of accomplishing one rather than two transplants. However, SKTs yield excellent outcomes when performed at experienced centers.

National impact of pulsatile perfusion on cadaveric kidney transplantation.

BACKGROUND: The simplicity and success of cold storage of cadaveric kidneys have led to the infrequent use of pulsatile perfusion. However, there may be advantages to pulsatile perfusion for less optimal donors. METHODS: United Network for Organ Sharing data were analyzed retrospectively to determine the impact of pulsatile perfusion on initial function and 1-year graft survival. The analysis included 60,827 cadaveric kidney transplants performed between 1988 and 1995. Multivariate logistic regression analyses were used to determine the effect of preservation method on both early kidney function (need for first-week dialysis after transplant) and 1-year graft survival, after adjusting for other known risk factors. RESULTS: The preservation method exhibited a highly significant impact on the need for first-week dialysis. Ice-preserved kidneys were associated with a 2.13-fold increase in the odds of requiring dialysis compared with perfused kidneys. If the donor age was > or =55 years, the odds were 2.33-fold higher for ice-preserved as compared with perfused. If cold ischemic time was > or =24 hr, there was a 2.19-fold increase in the odds of dialysis for ice-preserved kidneys. African-American recipients of cold-stored kidneys had a 2.29-fold greater odds of first-week dialysis. CONCLUSIONS: Based on these findings, it was estimated that the increased cost of perfusing kidneys from all donors > or =55 years of age would be balanced by the decreased need for posttransplant dialysis if the cost related to dialysis were $14,700 or greater per patient. These facts, coupled with the ability to assess an older donor kidney before transplant, could make pulsatile perfusion for the expanded donor financially as well as medically desirable.

SRTR center-specific reporting tools: Posttransplant outcomes.

Measuring and monitoring performance--be it waiting list and posttransplant outcomes by a transplant center, or organ donation success by an organ procurement organization and its partnering hospitals--is an important component of ensuring good care for people with end-stage organ failure. Many parties have an interest in examining these outcomes, from patients and their families to payers such as insurance companies or the Centers for Medicare and Medicaid Services; from primary caregivers providing patient counseling to government agencies charged with protecting patients. The Scientific Registry of Transplant Recipients produces regular, public reports on the performance of transplant centers and organ procurement organizations. This article explains the statistical tools used to prepare these reports, with a focus on graft survival and patient survival rates of transplant centers--especially the methods used to fairly and usefully compare outcomes of centers that serve different populations. The article concludes with a practical application of these statistics--their use in screening transplant center performance to identify centers that may need remedial action by the OPTN/UNOS Membership and Professional Standards Committee.

Organ donation in the United States: 1990-1998.

1. There were 5,799 cadaver and 4,274 living donors recovered in 1998, 29% and 101% increases, respectively, over those recovered in 1990. 2. The number of cadaver donors aged 50 or older has increased from 16% of all donors in 1990 to 29% of all donors in 1998. 3. The typical cadaver donor in 1998 was a White male with ABO blood type O between the ages of 18-34. In 1998, a typical living donor was a White female with ABO blood type O between the ages of 35-49. 4. Between 1990 and 1998, the percentage of minority donors increased for cadaver donors (18% to 24%), and for living donors (24% to 27%). 5. The number of living donors who were either spouses or unrelated to the recipient increased from 5% in 1990 to 18% in 1998. 6. California (10.2%) was most often listed as the state of residence for cadaver donors, followed by Texas (7.3%) and Florida (7.0%). 7. Cadaver donors are recovered most often on Tuesdays (15.2%), followed by Wednesdays (14.6%) and Fridays (14.3%). 8. Living donors are recovered most often on Wednesdays (32.4%), followed by Tuesdays (27.5%) and Thursdays (21.3%). 9. Cadaver donors are recovered most often in August and May (8.8%), followed by July and October (8.7%). 10. Living donors are recovered most often in June (10.5%), followed by July (10.0%) and August (8.3%). 11. In 1998, there were 21.4 donors recovered per million population in the United States.

The UNOS OPTN waiting list and donor registry.

1. On October 31, 1997, there were 55,789 registrations on the combined UNOS waiting list. Of these, two-thirds were awaiting kidney transplantation, and 17% were awaiting liver transplantation. 2. More than one-half of all patients on the UNOS waiting list on October 31, 1997 had blood type O, 59% were White, 58% were male, and 54% were aged 18-49. 3. Annual additions to the UNOS kidney waiting list grew from 11,916 in 1988 to 18,253 in 1996. The largest increase in waiting list size was seen in the lung waiting list, which grew 1,482% during this time. 4. Median waiting times have increased steadily for nearly every organ since 1988, especially for liver, kidney, and lung registrants. 5. For patients added to the waiting list in 1995, MWTs to transplant were longest for heart-lung registrants (887 days); however, no median could be calculated for kidney registrants added in 1995. The shortest waiting times for this cohort were experienced by heart registrants (208 days). 6. Death rates per 1,000 patient-years at risk have declined during 1988-1996. Death rates were higher for patients awaiting life-saving organs (liver, heart, lung, heart-lung) than for non-lifesaving organs (kidney, pancreas, kidney-pancreas). 7. There were 5,417 cadaveric and 3,553 living donors recovered in 1996, a 33% and 95% increase, respectively, over those recovered in 1988. 8. The number of organs recovered per cadaveric donor increased from 3.0 in 1988 to 3.8 in 1994 and dropped to 3.6 in 1996. At the same time, the number of organs transplanted per cadaveric donor recovered increased from 2.7 to 3.2. 9. Large increases in the number of donors who were liver (45-82%), pancreas (14-23%), and lung (3-14%) donors occurred between 1988 and 1996. 10. The number of cadaveric donors aged 50 or older has increased from 12% of all donors in 1988 to 27% of all donors in 1996. 11. The typical cadaveric donor in 1996 was a White male with ABO blood type O, between the ages of 18-34. In 1996, a typical living donor was a White female with ABO blood type O between the ages of 35-49. 12. Between 1988 and 1996, the percentage of minority donations increased for cadaveric donors (17-23%), and for living donors (24-27%). 13. The number of living donors who were either spouses or unrelated to the recipient increased from 4% in 1988 to 14% in 1996.

The UNOS OPTN Waiting List and Donor Registry: 1988-1996.

1. There were 49,233 registrations on the combined UNOS waiting list as of October 31, 1996, an increase of 207% over December 31, 1988. Of these, 69% were awaiting kidney transplantation, and 14.6% were awaiting liver transplantation. 2. More than one-half of all patients on the UNOS waiting list on October 31, 1996 were blood type O, 60% were White, 58% were male, and 56% were aged 18-49. 3. Annual additions to the UNOS kidney waiting list grew from 11,909 in 1988 to 17,635 in 1995. The largest increase in waiting list size was in the lung waiting list, which grew from 126 additions in 1988 to 1,706 additions in 1995. 4. For patients registering in 1994, median waiting times to transplant were longest for kidney registrants (842 days), followed by heart-lung registrants (612 days). The shortest waiting times for this cohort were experienced by liver registrants (173 days). 5. In general, death rates per 1,000 patient years at risk have declined during 1988-1995. Death rates were higher for patients awaiting life-saving organs (liver, heart, lung, heart-lung) than for non-lifesaving organs (kidney, pancreas, kidney-pancreas). 6. There were 5,359 cadaveric and 3,215 living donors recovered in 1995, a 31% and 76% increase, respectively, over the numbers recovered in 1988. 7. The number of organs recovered per cadaveric donor increased from 2.98 in 1988 to 3.68 in 1995. At the same time, the number of organs transplanted per cadaveric donor recovered increased from 2.73 to 3.24. 8. Large increases were seen in the number of recovered donors who were liver (45-81%), pancreas (14-24%), and lung (3-17%) donors between 1988-1995. 9. The number of cadaveric donors aged 50 or older has increased 172% from 1988 (475 donors) to 1995 (1,292 donors). 10. The typical cadaveric donor in 1995 was a White male with blood type O, between the ages 18-34. In 1995, a typical living donor was a White female with blood type O, aged 35-49. 11. Between 1988-1995, the percentage of minority donation has increased for cadaveric donors (16.4-22.8%), and for living donors (24.0-27.5%). 12. The number of spouses or other unrelated living donors has increased from 4% in 1988 to 11% in 1995.

Organ donation in the United States: 1988-2000.

Based upon information reported to the United Network for Organ Sharing: 1. There were 5,985 cadaveric and 5,702 living donors recovered in 2000, a 47% and 213% increase, respectively, over those recovered in 1988. 2. The number of cadaveric donors aged 50 or older has increased from 12% of all donors in 1988 to 31% of all donors in 2000. 3. The typical cadaveric donor in 2000 was a white male with ABO blood type O between the ages of 18-34. In 2000, a typical living donor was a white female with ABO blood type O between the ages of 35-49. 4. Between 1988-2000, the percentage of minority donors increased for cadaveric donors (17% to 26%), and for living donors (24% to 31%). 5. The number of living donors who were either spouses or unrelated to the recipient increased from 4% in 1988 to 26% in 2000. 6. In 2000, California (9.6%) was most often listed as the state of residence for cadaveric donors, followed by Texas (7.7%) and Florida (7.3%). 7. In 2000, cadaveric donors were recovered most often on Tuesdays (15.0%), followed by Thursdays (14.8%) and Fridays (14.7%). 8. In 2000, living donors were recovered most often on Wednesdays (27.8%), followed by Tuesdays (26.7%) and Thursdays (19.9%). 9. In 2000, cadaveric donors were recovered most often in July (9.2%), followed by September (9.0%), January and April (8.7%). 10. In 2000, living donors were recovered most often in June (9.5%), followed by November (9.2%) and August (9.0%).

The UNOS OPTN waiting list and donor registry.

1. On October 31, 1998, there were 62,994 registrants on the combined UNOS waiting list. Of these, 66% were awaiting kidney transplantation, and 18% were awaiting liver transplantation. 2. The majority of patients on the UNOS waiting list on October 31, 1998 were blood type O (52%), White (60%) and male (58%). 3. Median waiting times (MWTs) have increased steadily for nearly every organ since 1988, especially for liver, kidney, and lung registrants. 4. For patients added to the waiting list in 1996. MWTs to transplant were longest for heart-lung registrants (742 days). The shortest waiting times for this cohort were among heart registrants (223 days). No median could be calculated for kidney registrants added in 1996. 5. Death rates per patients waiting at risk declined during 1988-1997. Death rates were higher for patients awaiting life-saving organs (liver, heart, lung, heart-lung) than for non-lifesaving organs (kidney, pancreas, kidney-pancreas). 6. There were 5,478 cadaveric and 3,820 living donors recovered in 1997, a 34% and 109% increase over those recovered in 1988. 7. Large increases were seen in the number of liver (45-84%), pancreas (14-24%), and lung (3-15%) donors between 1988-1997. 8. The number of cadaveric donors aged 50 or older has increased from 12% of all donors in 1988 to 28% of all donors in 1997. 9. The typical cadaveric donor in 1997 was a white male with ABO blood type O, between the ages of 18-34. In 1997, a typical living donor was a white female with ABO blood type O between the ages of 35-49. 10. Between 1988-1997, the percentage of minority donation increased for cadaveric donors (17-24%), and for living donors (23-27%). 11. The number of living donors who were either spouses or unrelated to the recipient increased from 4% in 1988 to 15% in 1997.

Organ procurement organization (OPO), best practices.

There are currently 59 organ procurement organizations (OPOs) in the United States which serve their assigned geographic areas with variable productivity. Knowledge of organizational characteristics, programs and practices of more successful OPOs may be useful to increase the productivity of less successful OPOs. A preliminary survey of all OPO executive directors in the United States ascertained the most important beneficial and detrimental factors affecting their success. Site visits were then conducted at OPOs based on a selection process utilizing population size, geographic location, minority population, donors per million population and donors per thousand deaths among potential donors. All OPOs were categorized and the highest ranking OPOs in each of seven categories, based on 4 years of national data, were selected for the site visits. Regression analysis and correlation analysis using Pearson's product-moment correlation were performed. The survey to identify the important factors was returned by 47 (77%) of 61 OPOs existent in 1999. The most important beneficial factors identified by responding OPOs were adequate staffing and experience, allocation of responsibilities, hospital development and leadership. The most important detrimental factors were inadequate staffing and experience, poor donor hospital/transplant center/ OPO relationships and failure in the consent process. Site visits of the highest-ranking OPOs demonstrated all had respected, experienced leadership focused on the donation process; efficient mechanisms for resolving allocation or transplant center conflicts; systems for monitoring activity and tracking outcomes; excellent communication between OPO and transplant centers; open internal communication at all levels of the OPO; immediate, on-site response to vascular donor referrals; and volunteer support of public and/or professional education. Regression and correlation analysis demonstrated that as minority population increases, OPO performance declines (P < 0.03). Moreover, independent OPOs were associated with poorer performance regardless of minority population (P < 0.05). All of the successful OPOs visited had strong leadership, excellent donor hospital and transplant center relationships, well-developed communication and innovative methods to deal with their minority populations. Application of these practices within all OPOs could significantly enhance organ donation.