Benchmarking organ procurement organizations: a national study.

OBJECTIVE: An exploratory examination of the technical efficiency of organ procurement organizations (OPOs) relative to optimal patterns of production in the population of OPOs in the United States. DATA SOURCES: A composite data set with the OPO as the unit of analysis, constructed from a 1995 national survey of OPOs (n = 64), plus secondary data from the Association of Organ Procurement Organizations and the United Network for Organ Sharing. STUDY DESIGN: The study uses data envelopment analysis (DEA) to evaluate the technical efficiency of all OPOs. PRINCIPAL FINDINGS: Overall, six of the 22 larger OPOs (27 percent) are classified as inefficient, while 23 of the 42 smaller OPOs (55 percent) are classified as inefficient. Efficient OPOs recover significantly more kidneys and extrarenal organs; have higher operating expenses; and have more referrals, donors, extrarenal transplants, and kidney transplants. The quantities of hospital development personnel and other personnel, and formalization of hospital development activities in both small and large OPOs, do not significantly differ. CONCLUSIONS: Indications that larger OPOs are able to operate more efficiently relative to their peers suggest that smaller OPOs are more likely to benefit from technical assistance. More detailed information on the activities of OPO staff would help pinpoint activities that can increase OPO efficiency and referrals, and potentially improve outcomes for large numbers of patients awaiting transplants.     

Using a standardized donor ratio to assess the performance of organ procurement organizations

OBJECTIVE: To develop a Standardized Donor Ratio (SDR) as an outcome measure for evaluating the effectiveness of organ procurement organizations (OPOs). DATA SOURCES/STUDY SETTING: All deaths by cause in the United States during 1993-1994 as reported in the Vital Mortality Statistics, Multiple Cause of Death files. The OPO-specific data were provided by the United Network for Organ Sharing (UNOS). STUDY DESIGN: Each OPO's expected number of donors was calculated by applying national donation rates to deaths with potential for donation in 24 age, sex, and race cells. The SDR was calculated by dividing the observed number of donors by the expected number. The chi2 tests of the hypothesis that the OPO's performance differed from the national norm of 1.0 were performed. The SDR was compared to the existing performance standard based on the unadjusted number of donors per million live population in the OPO's service area. An ordinary least squares (OLS) regression assessed predictors of the SDR. PRINCIPAL FINDINGS: The SDRs ranged from 0.41 to 1.99. Twenty-nine of 64 OPOs had SDRs significantly different than 1.0. The SDRs were positively associated with the percent of white living population and the number of organ types transplanted per transplant center served by the OPO. CONCLUSIONS: The SDRs can be used by Centers for Medicare and Medicaid Services (CMS), UNOS, and OPOs to target quality improvement initiatives, present more accurate comparisons of OPO performance, and develop public policy on the evaluation of the effectiveness of organ procurement efforts.     

E-commerce for healthcare supply procurement

The total investment of the more than fifty e-commerce startups that entered healthcare supply chain management in the past three years has surpassed $500 million. However, none of these early entrants has delivered on the initial promise of restructuring the entire supply chain, replacing the traditional intermediaries, or at least achieving substantial revenue. This article offers a new business-to-business (B2B) e-commerce solution classification paradigm and uses it to analyze the functional requirements for an effective and, efficient healthcare supply chain marketplace. The analysis exposes several fundamental B2B market complexities that prevent the early entrants from creating a solid customer base and reaching desired liquidity goals. It also identifies several technological solutions to the problems mentioned. These new technologies create a comprehensive and symmetric order-matching engine that is capable of aggregating buy orders, requesting quotes from multiple vendors simultaneously, and negotiating along multiple criteria.     

Death and organ procurement: public beliefs and attitudes

While brain death and the dead donor rule (patients must not be killed by organ retrieval) have been clinically and legally accepted in the US as a prerequisite to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents >or=18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: brain dead, in a coma, or in a persistent vegetative state (PVS). Respondents' provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. Over 98% of respondents had heard of the term brain death, but only one-third (33.7%) believed that someone who was brain dead was legally dead. The majority of respondents (86.2%) identified the brain dead patient in the first scenario as dead, 57.2% identified the patient in a coma as dead (Scenario 2), and 34.1% identified the patient in a PVS as dead (Scenario 3). Nearly, a third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed or held beliefs that were not congruent with current definitions of brain death. This study highlights the need for more public dialogue and education about brain death and organ donation.     

Difficult communication: compliance-gaining strategies of organ procurement coordinators

Organ procurement coordinators (OPCs) face a formidable communication task when making familial requests for consent to organ donation, because they must provide social support for grieving family members while seeking compliance to the donation request. Structured interviews were conducted with 102 OPCs, representing 16 organ procurement organizations (OPOs) (27.6% of national organizations) across the United States. Responses were transcribed and content-analyzed along four domain areas: (a) establishing credibility, (b) message strategies, (c) timing/setting of requests, and (d) adaptation of messages to diverse families. OPO conversion rates were used as a criterion factor for OPCs' persuasive communication success and regressed onto self-reported strategy use. Results indicate message strategies varied at the OPC level of analysis and 7 techniques significantly predicted 32% of the variance in conversion rates. Two strategies (i.e., gaining early intervention, approaching with additional support) positively influenced conversion rates, whereas 5 strategies (e.g., discussing benefits as a persuasive strategy, emphasizing the need for donation in particular racial/ethnic groups) negatively influenced conversion rates. Future research is recommended to validate the study findings toward the goal of improving OPCs' communication strategies.     

A method for estimating solid organ donor potential by organ procurement region.

OBJECTIVES: This study sought to develop a methodology for estimating potential solid organ donors and measuring donation performance in a geographic region based on readily available data on the hospitals in that region. METHODS: Medical records were reviewed in a stratified random sample of 89 hospitals from 3 regions to attain a baseline of donor potential. Data on a range of hospital characteristics were collected and tested as predictors of donor potential through the use of hierarchical Poisson regression modeling. RESULTS: Five hospital characteristics predicted donor potential: hospital deaths, hospital Medicare case-mix index, total hospital staffed beds, medical school affiliation, and trauma center certification. Regional estimates were attained by aggregating individual hospital estimates. Confidence intervals for these regional estimates indicated that actual donations represented from 28% to 44% of the potential in the regions studied. CONCLUSIONS: This methodology accurately estimates organ donor potential within 3 geographic regions and lays the foundation for evaluating organ donation effectiveness nationwide. Additional research is needed to test the validity of the model in other geographic regions and to further explore organ donor potential in hospitals with fewer than 50 beds.     

EDI enables big cuts in supply procurement costs

Many providers are turning to information technology to improve the supply procurement process as well as reduce supply utilization. These providers are saving money and time by using such technologies as EDI, the Internet, bar coding, purchasing cards and automated supply stations.     

The benefit of smart phone usage in liver organ procurement

A 56-year-old man was on the transplant list with end-stage liver disease secondary to hepatitis C when a donor liver became available at a location 545 km away. The procurement team, consisting of a senior and junior fellow, went on the retrieval, while the staff surgeon remained in the hospital with the recipient. At the time of organ procurement, a suspicious lesion was identified in the left lateral lobe. The transplant fellows took intraoperative pictures of the lesion with a smart phone and sent them to the staff surgeon for advice. A teleconsultation, facilitated by images sent from the smart phone, took place over the next 22 min. The decision was made to proceed with the transplant, as it was felt that the lesion could be resected from the liver allograft. Had the fellows not been able to interact with the staff surgeon in real-time during the surgery, there is a high likelihood that the organ would have been rejected by the staff surgeon due to the unexpected finding. The patient's postoperative course was relatively uneventful with no evidence of infection. The patient was discharged from hospital and continues to do well. We expect that the role of smart phones in remote consultation will continue to expand in future.     

Profiling efficiency and quality of physician organizations in Medicare

This article presents a methodology for profiling the cost efficiency and quality of care of physician organizations (POs). The method is implemented for the Boston metropolitan area using 2002 Medicare claims. After adjustments for case mix and other factors, 4 of 30 organizations are identified with different than average efficiency Twenty-one of 30 organizations are identified with a different composite quality of care than average. Without changes in PO behavior, the gains from redirecting patients from lower to higher efficiency and quality providers are likely to be limited.     

Profiling efficiency and quality of physician organizations in Medicare

This article presents a methodology for profiling the cost efficiency and quality of care of physician organizations (POs). The method is implemented for the Boston metropolitan area using 2002 Medicare claims. After adjustments for case mix and other factors, 4 of 30 organizations are identified with different than average efficiency Twenty-one of 30 organizations are identified with a different composite quality of care than average. Without changes in PO behavior, the gains from redirecting patients from lower to higher efficiency and quality providers are likely to be limited.     

Protecting autonomy in organ procurement procedures: some overlooked issues

Organ procurement personnel in the United States appear to be unaware that the standard practice of asking the surviving families of all classes of potential donors (declared and undeclared) for permission to remove organs and tissues from these individuals is inconsistent with the provisions of most state UAGAs. The majority of these Acts vest first authority concerning the donation of body parts in those individuals whose organs and tissues are needed and judged medically acceptable for removal and transfer. These laws do not give families the right to veto the positive written declarations of dead relatives who have authorized the posthumous taking of their own body parts. Hence, seeking family consent for the removal of body parts from registered donors is unnecessary and inappropriate according to the provisions of most state UAGAs. The primary authority given to individuals under this legislation to control the taking of organs and tissues from their bodies after death arguably rests on the plausible premise that a person's body is his or her property in a significant sense. This gives individuals first authority to control the posthumous disposition of their body parts. Under current retrieval practice, however, families of deceased registered donors are seldom informed about the paramount rights of these individuals and are led to believe that they have final legal authority over the disposition of organs and tissues from these expatients. This is, in effect, an unwitting but nonetheless serious "sellout" of the moral-legal rights of these potential donors. I have attempted to show the weakness of one plausible line of argument for the claim that current retrieval practice with its family priority orientation ought to be continued in unamended form, irrespective of what the law says. I suggested an alternative procedure for approaching the surviving families of registered donors which I believe offers a socially acceptable compromise among three values which enter into competition at the death of a declared donor: (1) saving the maximum number of lives of ESOD victims, (2) respecting and protecting the rights of declared donors, and (3) honoring the needs of the grieving family.(ABSTRACT TRUNCATED AT 400 WORDS)     

The changing nature of organ procurement policies and the implications for the UK

The shift away from socialized forms of welfare over the past twenty years has changed the symbolic basis on which bodily parts are exchanged. Titmuss viewed the newly-formed National Health Service in the United Kingdom as a vehicle for institutionalizing altruistic practices, notably the voluntary "gift" of blood to strangers represented by the transfusion service. More recent advances in medical technology have made new forms of bodily tissue donation possible, including the transplantation of whole organs. Yet the excess of demand over supply is forcing a change from the principle of voluntarism on which "opting-in" procurement arrangements have hitherto rested to one of presumed consent and the system of "opting-out" adopted in other countries. The implications of this transition within the context of late twentieth century multi-cultural Britain are examined.     

The role of the relatives in opt-in systems of postmortal organ procurement

In almost all opt-in systems of postmortal organ procurement, if the deceased has not made a decision about donation, his relatives will be asked to make it. Can this decision power be justified? I consider three possible justifications. (1) We could presume the deceased to have delegated this power to his relatives. (2) It could be argued that, if the deceased has not made a decision, a proxy decision has to be made in his best interests. (3) The relatives could have a standing of their own because they are singled out from the parties whose interests are being affected by the decision by the special relation they had to the deceased. None of these arguments turns out to be convincing.     

Competition for altruism: bone and organ procurement in the United States.

The number of "units" of human bone used during surgical procedures has grown to almost a quarter of a million. Medical demand for such bone is expanding rapidly and the nation's bone-banking system is struggling to grow apace. Unfortunately, because of this growth, bone banks must compete with organ banks for access both to hospitals and to potential donors. This conflict can, and may already be, negatively affecting the supply of transplantable tissues and organs. The nature of this conflict is affected by current law and public policy, but those effects are little understood and perhaps not intended.     

新加坡药品采购供应模式研究及对我国的政策建议

通过对新加坡药品采购供应模式的系统介绍,总结其药品采购供应的流程、特点和经验,为我国药品采购供应模式提供相应政策建议。