Development of a Standard Donor Ratio (SDR): A tool for evaluating and improving the effectiveness of the organ procurement organizations in the United States.

Abstract

In 1997, there were over 50,000 people waiting for an organ transplant. The organ procurement process is a complex series of events, coordinated by professionals in 66 Organ Procurement Organizations (OPOs) in the United States. These OPOs are federally funded, non-profit organizations. The principle goal of OPOs is to procure the maximum number of organ donors from their designated service area. No valid measure of effectiveness has been used to assess the performance of OPOs. The primary goal of this research was to develop a valid outcome measure of effectiveness. The result was a method that accurately assessed performance and variability of OPOs, adjusted for the population each serves. The research was conducted using mortality and organ donation data to compare individual OPO donor procurement rates to national rates. The information allowed the development of national donor rates from all potential organ donors. Based on the national rates derived from data on over 4.6 million deaths during 1993--1994, a methodology is described that allows for comparison of individual OPO donor rates to the national donor rate. These rates were stratified by age, sex, and race categories. A Standardized Donor Ratio (SDR) is introduced to provide an outcome measure of effectiveness for evaluation of each OPO and comparison between OPOs. To enhance the usefulness of the SDR, a survey was developed and sent to all OPO leaders to gather specific organizational information that might explain some of the variance in SDR scores between OPOs. The response rate was 42%. A contingency model of how OPO structure and characteristics are related to the SDRs was developed. The model contends that OPOs will have internal structures to match the characteristic of the external environment, increasing their effectiveness. This methodology, and the information derived from it, can be used by the Health Care Financing Administration, UNOS, and OPOs to develop local and national quality improvement priorities, present accurate comparison of OPO performance, and encourage public policy regarding the appropriate evaluation of the effectiveness of organ procurement efforts.