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).


METHODS
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).


METHODS
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.


RESULTS
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.
Stogis
Sheryl
S
Alexian Brothers Health System, Elk Grove Village, IL, USA.
Hirth
Richard A
RA
Strawderman
Robert L
RL
Banaszak-Holl
Jane
J
Smith
Dean G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D014487:Centers for Medicare and Medicaid Services, U.S.; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008330:Management Audit / Q000379:methods*; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods*; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States; D014850:Waiting Lists