OPTN/SRTR 2020 Annual Data Report: DOD.

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 2020, there were 12,588 deceased donors, an increase from 11,870 in 2019; this number has been increasing since 2010. The number of deceased donor transplants increased to 33,303 in 2020, from 32,313 in 2019; this number has been increasing since 2012. The increase may be due in part to the rising number of deaths of young people amid the ongoing opioid epidemic. The number of organs transplanted included 18,410 kidneys, 962 pancreata, 8350 livers, 91 intestines, 3722 hearts, and 2463 lungs. Compared with 2019, transplants of all organs except pancreata and lung transplants increased in 2020, which is remarkable despite the pandemic caused by the SARS-CoV2 virus. In 2020, 4870 kidneys, 294 pancreata, 861 livers, 3 intestines, 39 hearts, and 115 lungs were discarded. The number of discards was similar to that of the previous year. 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. Despite the pandemic, there was no dramatic increase in number of discards and an increase in total number of donors and transplants.

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.

A scientific registry of transplant recipients bayesian method for identifying underperforming transplant programs.

In response to recommendations from a recent consensus conference and from the Committee of Presidents of Statistical Societies, the Scientific Registry of Transplant Recipients explored the use of Bayesian hierarchical, mixed-effects models in assessing transplant program performance in the United States. Identification of underperforming centers based on 1-year patient and graft survival using a Bayesian approach was compared with current observed-to-expected methods. Fewer small-volume programs (<10 transplants per 2.5-year period) were identified as underperforming with the Bayesian method than with the current method, and more mid-volume programs (10-249 transplants per 2.5-year period) were identified. Simulation studies identified optimal Bayesian-based flagging thresholds that maximize true positives while holding false positive flagging rates to approximately 5% regardless of program volume. Compared against previous program surveillance actions from the Organ Procurement and Transplantation Network Membership and Professional Standards Committee, the Bayesian method would have reduced the number of false positive program identifications by 50% for kidney, 35% for liver, 43% for heart and 57% for lung programs, while preserving true positives for, respectively, 96%, 71%, 58% and 83% of programs identified by the current method. We conclude that Bayesian methods to identify underperformance improve identification of programs that need review while minimizing false flags.

Bayesian methods for assessing transplant program performance.

Based on recommendations from a recent consensus conference and a report commissioned by the Centers for Medicare & Medicaid Services to the Committee of Presidents of Statistical Societies, the Scientific Registry of Transplant Recipients (SRTR) plans to adopt Bayesian methods for assessing transplant program performance. Current methods for calculating program-specific reports (PSRs) often generate implausible point estimates of program performance, wide confidence intervals and underpowered conventional statistical tests. Although technically correct, these methods produce statistical summaries that are prone to misinterpretation. The Bayesian approach assumes that performance of most programs is about average and few programs perform much better or much worse than average; thus, strong evidence is required to conclude that performance is extremely good or poor. In Bayesian statistics, inference is performed via a posterior probability distribution, which reflects both the available data and prior beliefs about what model parameter values are most likely. In the PSRs, the posterior distribution of a program-specific hazard ratio will show whether a program is likely to be performing better or worse than average. Bayesian-derived PSRs will be available for preview by programs on the private SRTR website in mid-2014 and will likely replace current methods for public reporting in early 2015.

New quality monitoring tools provided by the Scientific Registry of Transplant Recipients: CUSUM.

The Scientific Registry of Transplant Recipients (SRTR) has been providing data on transplant program performance through semi-annual release of program-specific reports (PSRs). A consensus conference held in February 2012 recommended that SRTR also supply transplant programs with tools such as the cumulative sum (CUSUM) technique to facilitate quality assessment and performance improvement. SRTR developed the process, methodologies, programming code and web capabilities necessary to bring the CUSUM charts to the community, and began releasing them to all liver, kidney, heart and lung programs in July 2013. Observed-minus-expected CUSUM charts provide a general picture of a program's performance (all-cause graft failure and mortality within the first-year posttransplant) over a 3-year period; one-sided charts can determine when performance appears to be sufficiently worrisome to warrant action by the program. CUSUM charts are intended for internal quality improvement by allowing programs to better track performance in near-real time and day to day, and will not be used to indicate whether a program will be flagged for review. The CUSUM technique is better suited for real-time quality monitoring than the current PSRs in allowing monthly outcomes monitoring and presenting data recorded as recently as 2 months before the release of the CUSUM charts.

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.