Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield |
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Authors: | Andrew Wey Maryam Valapour Melissa A. Skeans Nicholas Salkowski Monica Colvin Bertram L. Kasiske Ajay K. Israni Jon J. Snyder |
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Affiliation: | 1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA;2. Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA;3. Department of Cardiology, University of Michigan, Ann Arbor, MI, USA;4. Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA;5. Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA |
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Abstract: | Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. To investigate these issues, offer acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) were estimated using offers from donors recovered July 1, 2016, and June 30, 2017. Logistic regressions estimated the association of DSA‐level offer acceptance ratios with donor yield and local placement of organs recovered in the DSA. Competing risk methodology estimated the association of program‐level offer acceptance ratios with incidence and rate of waitlist removals due to death or becoming too sick to undergo transplant. Higher DSA‐level offer acceptance was associated with higher yield (odds ratios [ORs]: lung, 1.041.111.19; heart, 1.091.211.35) and more local placement of transplanted organs (ORs: lung, 1.011.121.24; heart, 1.471.691.93). Higher program‐level offer acceptance was associated with lower incidence of waitlist removal due to death or becoming too sick to undergo transplant (hazard ratios [HRs]: heart, 0.800.860.93; lung, 0.670.750.83), but not with rate of waitlist removal (HRs: heart, 0.910.981.06; lung, 0.890.991.10). Heart and lung offer acceptance practices affected numbers of transplanted organs and contributed to program‐level variability in the probability of waitlist mortality. |
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Keywords: | clinical research/practice organ acceptance organ procurement and allocation Scientific Registry for Transplant Recipients (SRTR) |
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