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.     

Potential organ-donor supply and efficiency of organ procurement organizations

The authors estimated the supply of organ donors in the U.S. and also according to organ procurement organizations (OPOs). They estimated the number of donors in the U.S. to be 16,796. Estimates of the number of potential donors for each OPO were used to calculate the level of donor efficiency (actual donors as a percent of potential donors). Overall, donor efficiency for OPOs was 35 percent; the majority was between 30- and 40-percent efficient. Although there is room to improve donor efficiency in the U.S., even a substantial improvement will not meet the Nation's demand for organs.     

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.     

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.     

More potential organ donors than actual donations in 52 intensive-care units in the Netherlands, 2001-2004

OBJECTIVE: To assess the number of potential organ donors and the main reasons why organ donation is not performed. DESIGN: Retrospective. METHOD: The number of potential heart-beating (HB) and non-heart-beating (NHB) donors was assessed by reviewing the medical records of 588o patients who died between 2001 and 2004 in 52 intensive-care units (ICUs) in 30 hospitals. The number of actual donations was also assessed. RESULTS: The potential of HB donors was 2.5 to possibly 6.6% of all ICU deaths and HB donation was performed in 1.9% of all ICU deaths. The potential of NHB donors of category III was at least 4.2% of all ICU deaths and NHB donation was performed in 1.0% of all ICU deaths. The main difficulty in the donation process was objection from family members, which was reported in 45% of all potential HB and NHB donors and in 59% of all donation requests to relatives. Of the potential HB and NHB donors 7.3% were not identified as potential donors. CONCLUSION: These results confirm that organ-donor potential is greater than the number of actual donations. Objection from family members is the main limiting factor.     

我国人体器官获取组织建设与规范化管理的探讨

器官获取组织（OPO）是随着器官移植事业发展而产生的新生组织,其建立和管理尚无统一的标准或模式.通过分析我国建立OPO的必要性以及OPO建设和发展中存在的问题,提示应采取加大宣传教育力度、规范OPO的运行流程、建立规范化OPO经济管理措施、加强OPO成员专业化培训、采取适当的激励措施、加强器官捐献移植系统信息化建设等对策,旨在推动OPO的发展,规范器官移植工作.     

A methodological framework for optimally reorganizing liver transplant regions.

BACKGROUND: The United States is divided currently into 11 transplant regions, which vary in area and number of organ procurement organizations (OPOs). Region size affects organ travel time and organ viability at transplant. PURPOSE: To develop a methodologic framework for determining optimal configurations of regions maximizing transplant allocation efficiency and geographic parity. METHODS: An integer program was designed to maximize a weighted combination of 2 objectives: 1) intraregional transplants, 2) geographic parity-maximizing the lowest intraregional transplant rate across all OPOs. Two classes of functions relating liver travel time to liver viability were also examined as part of the sensitivity analyses. RESULTS: Preliminary results indicate that reorganizing regions, while constraining their number to 11, resulted in up to 17 additional transplants/year depending on the travel-viability function; when not constrained, it resulted in up to 18/year of increase. CONCLUSION: Our analysis indicates that liver transplantation may benefit through region reorganization. The analytic method developed here should be applicable to other organs and sets of organs.     

Transplantation-transmitted tuberculosis--Oklahoma and Texas, 2007

Approximately 28,000 organ transplants were performed in the United States in 2007. When infections are transmitted from donors, the implications can be serious for multiple recipients. Tuberculosis (TB), a known infectious disease complication associated with organ transplantation, occurs in an estimated 0.35%-6.5% of organ recipients in the United States and Europe posttransplantation. In 2007, the Oklahoma State Department of Health identified Mycobacterium tuberculosis in an organ donor 3 weeks after the donor's death. This report summarizes results of the subsequent investigation, which determined that disseminated TB occurred in two of three transplant recipients from this donor, and one recipient died. Genotypes of the donor and recipient TB isolates were identical, consistent with transmission of TB by organ transplantation. To reduce the risk for TB transmission associated with organ transplantation, organ recovery personnel should consider risk factors for TB when assessing all potential donors. In addition, clinicians should recognize that transplant recipients with TB might have unusual signs or symptoms. When transmission is suspected, investigation of potential donor-transmitted TB requires rapid communication among physicians, transplant centers, organ procurement organizations (OPOs), and public health authorities.     

Organ transplantation in Italy: Analysis of donors and recipients

The Istituto Superiore di Sanità (The Italian National Institute of Health) has been collecting information regarding organ donation and transplantation in Italy. Herein we describe organ procurement and transplant activity in Italy in the years 1992–1997 and show some of the characteristics regarding both donors and transplanted patients who received kidneys, hearts, livers and lungs. Although transplantation in Italy has been very difficult because of shortage of organ donors, national rates have been improving year after year. The present situation should ameliorate further to enable Italy to reach the same level of other advanced European countries.     

Gender imbalance in living organ donation

Living organ donation has developed into an important therapeutic option in transplantation medicine. However, there are some medico-ethical problems that come along with the increasing reliance on this organ source. One of these concerns is based on the observation that many more women than men function as living organ donors. Whereas discrimination and differential access have been extensively discussed in the context of cadaveric transplantation and other areas of health care, the issue of gender imbalance in living organ donation has received less attention. This paper presents relevant data from the Eurotransplant and UNOS transplantation systems and discusses possible explanations for the documented gender discrepancies. The conclusion calls for are view of existing practice guidelines in order to secure effective protection of particularly vulnerable potential donors and an equitable donor-recipient-ratio in living organ donation. This revised version was published online in July 2006 with corrections to the Cover Date.     

Cadaveric donotransplantation: nurses' attitudes, knowledge and behaviour

Human organ transplantation is an important treatment for certain medical conditions, and for irreversible organ failure. There is a shortfall in the number of organs required for transplantation. The close and continuous proximity of nurses to potential donors and their families make them critical links in the organ donation process. Therefore, success in organ procurement may depend on nurses' awareness and integration of knowledge about donotransplantation (the process of organ/tissue donation and transplantation). Postal questionnaires were distributed throughout the United Kingdom (UK) to 2465 registered nurses, to assess their personal attitudes, knowledge and behaviour regarding cadaveric donotransplantation. One thousand, three hundred and thirty-three questionnaires were returned, a response rate of 54%. Overall, nurses held positive attitudes to donotransplantation, with 78% agreeing with organ donation and only 10% clearly being opposed. However, nurses were found to share ambivalent attitudes of altruism and fear which appear to surround decisions about donation. Factor analysis was used to further explore nurses' attitude structure. Six factors were confirmed providing a non-significant likelihood ratio fit (P = 0.468) and a well reproduced correlation matrix. The factors related to: (1) the value and contribution made by donotransplantation; (2) the unique idea of having another's tissue in one's own body; (3) the importance of organ donation; (4) the individual's moral, and nurses' professional rejection of the responsibility for organ/tissue donation; (5) the post-mortem mutilation of the body; and, (6) the potential distress donation may cause a bereaved family. Comparisons were made between certain of nurses' specialist groups and significant differences were found. Comparisons of factor scores between certain specialist groups or other strata were assessed by analysis of variance. Nurses working in renal units were significantly more in favour of donotransplantation than any other group of nurses.     

Reservations of the spirit: the development of a culturally sensitive spiritual beliefs scale about organ donation

This study investigated whether spiritual beliefs offered any explanation for why participants from Korea (N = 146), Japan (N = 134), and the United States (N = 146) were willing or reluctant to register as organ donors. A culturally appropriate measure of spiritual beliefs about organ donation, the Spiritual Beliefs Scale, was developed consisting of 2 factors: (a) Spiritual Connection and (b) Spiritual Concern. Spiritual Connection was a significant predictor of behavioral intention to become an organ donor for Korean respondents, whereas Spiritual Concern was a significant predictor of reluctance to become an organ donor for American respondents. Spiritual beliefs correlated as predicted with attitude toward organ donation and fear of bodily mutilation, showing that the Spiritual Beliefs Scale exhibited internal, external, and predictive validity. Across the 3-country sample, Spiritual Connection was associated with greater willingness to become an organ donor for women, whereas Spiritual Concern inhibited participation for men. Implications of these findings are discussed for developing culturally effective education and procurement campaigns.     

Reservations of the Spirit: The Development of a Culturally Sensitive Spiritual Beliefs Scale About Organ Donation

This study investigated whether spiritual beliefs offered any explanation for why participants from Korea (N?=?146), Japan (N?=?134), and the United States (N?=?146) were willing or reluctant to register as organ donors. A culturally appropriate measure of spiritual beliefs about organ donation, the Spiritual Beliefs Scale, was developed consisting of 2 factors: (a) Spiritual Connection and (b) Spiritual Concern. Spiritual Connection was a significant predictor of behavioral intention to become an organ donor for Korean respondents, whereas Spiritual Concern was a significant predictor of reluctance to become an organ donor for American respondents. Spiritual beliefs correlated as predicted with attitude toward organ donation and fear of bodily mutilation, showing that the Spiritual Beliefs Scale exhibited internal, external, and predictive validity. Across the 3-country sample, Spiritual Connection was associated with greater willingness to become an organ donor for women, whereas Spiritual Concern inhibited participation for men. Implications of these findings are discussed for developing culturally effective education and procurement campaigns.     

Correlates of willingness to consider organ donation among blacks

Professionals in the health care and organ procurement fields reveal that black Americans display limited commitment to organ donation. The present study represents an attempt to shed some light on this issue by examining the relationship of selected demographic, knowledge and attitude-belief variables to willingness to consider organ donation within a black population. Findings indicated that only a few of the demographic and knowledge variables were related to willingness to consider organ donation. All of the attitude-belief variables, however, were found to be significantly associated with the dependent variable. Implications of the findings for recruiting black organ donors and future research are discussed.     

Ethische Erwägungen zur Organtransplantation und zum Hirntodkriterium

For the moral evaluation of organ transplantations, it is not only relevant that they are potentially live-saving or significantly life-improving procedures. It is also relevant that they may have an impact on the integrity or even dignity of possible donors and are a potential strain on the donors' relatives. In order to find out how the different impacts of organ transplantation on the parties involved are to be morally weighed against one other, the concepts of dignity and of negative and positive moral rights are clarified. Against the widely held view that the procurement of organs from brain dead donors is morally suspect while living organ donation is the morally superior option, it is argued that there is a prima facie moral duty to postmortem organ donation. On the other hand, since in the procurement of organs from living donors physicians systematically injure and endanger healthy persons, this practice can only be morally justified in well-defined exceptional cases.     

Organ donation, retrieval, and transplantation in Italy, in 1994-98

Organ donation and transplantation activity in Italy have been always characterised by two contrasting features: first the constant positive trend in the improvement of the number of organ donors and transplants which allowed the country to exceed the value of 12 donors per million population in 1998; second the difficult situation in southern regions, so that the national distribution of the activity is highly and steadily non homogeneous. Herein we report the data regarding donation, retrievals and transplant activity in Italy in the years 1994-98, focusing on the activity of each region and the three interregional centres which encompass the majority of the national territory.     

Liver transplant allocation policies and outcomes in United States: A comprehensive review

Liver transplant allocation policies in the United States has evolved over 3 decades. The donor liver organs are matched, allocated and procured by the Organ Procurement and Transplantation Network which is administered by the United Network of Organ Sharing (UNOS), a not-for-profit organization governed by the United States human health services. We reviewed the evolution of liver transplant allocation policies. Prior to 2002, UNOS used Child-Turcotte-Pugh score to list and stratify patients for liver transplantation (LT). After 2002, UNOS changed its allocation policy based on model for end-stage liver disease (MELD) score. The serum sodium is the independent indicator of mortality risk in patients with chronic liver disease. The priority assignment of MELD-sodium score resulted in LT and prevented mortality on waitlist. MELD-Sodium score was implemented for liver allocation policy in 2016. Prior to the current and most recent policy, livers from adult donors were matched first to the status 1A/1B patients located within the boundaries of the UNOS regions and donor-service areas (DSA). We reviewed the disadvantages of the DSA-based allocation policies and the advantages of the newest acuity circle allocation model. We then reviewed the standard and non-standard indications for MELD exceptions and the decision-making process of the National Review Liver Review Board. Finally, we reviewed the liver transplant waitlist, donation and survival outcomes in the United States.     

Asking the difficult questions: message strategies used by organ procurement coordinators in requesting familial consent to organ donation

The present study provides an in-depth examination of the messages used by organ procurement coordinators (OPCs) in shaping familial requests for organ donation. OPCs (N?=?102), recruited from a national sample of 16 organ procurement organizations, participated in a structured interview designed to uncover the communication strategies used in obtaining familial consent for donation. Analysis of interviews indicates OPCs' messages cover 4 domain areas. Specifically, OPCs report use of messages intended to (a) provide education, (b) discuss the benefits to donation, (c) learn about potential donor families, and (d) persuade families to engage in donation. Within the 4 domain areas, OPCs report use of 15 specific messages (e.g., "positively framing the donor," "social proof," "discuss the benefit of donation to grieving") in requesting consent. The present study provides a detailed examination of strategies and offers recommendations for using message strategies to explore the effectiveness of the consent process from the perspective of OPCs in approaching donor families.     

Asking the Difficult Questions: Message Strategies Used by Organ Procurement Coordinators in Requesting Familial Consent to Organ Donation

The present study provides an in-depth examination of the messages used by organ procurement coordinators (OPCs) in shaping familial requests for organ donation. OPCs (N = 102), recruited from a national sample of 16 organ procurement organizations, participated in a structured interview designed to uncover the communication strategies used in obtaining familial consent for donation. Analysis of interviews indicates OPCs' messages cover 4 domain areas. Specifically, OPCs report use of messages intended to (a) provide education, (b) discuss the benefits to donation, (c) learn about potential donor families, and (d) persuade families to engage in donation. Within the 4 domain areas, OPCs report use of 15 specific messages (e.g., “positively framing the donor,” “social proof,” “discuss the benefit of donation to grieving”) in requesting consent. The present study provides a detailed examination of strategies and offers recommendations for using message strategies to explore the effectiveness of the consent process from the perspective of OPCs in approaching donor families.