From 2003-2006, the Health Resources and Services Administration (HRSA) sponsored and led a series of Organ Donation Breakthrough Collaboratives. The aim was to save or enhance thousands of lives a year by spreading known best practices to the nation’s largest hospitals to achieve donation rates of 75 percent or higher. Several measurable goals were identified. Hospitals and organ procurement organizations (OPOs) who met one or more of the following three goals were recognized by HRSA:
- 75% Conversion Rate
- 10% Donation after Circulatory Death
- 3.75 Organs Transplanted per Donor
Since then, donation performance has been measured against these metrics. The efforts of the collaborative were highly successful, resulting in a significant increase in donation and transplantation over the past years.
The donation and transplantation community continues to address the growing organ waitlist across the country. In November 2020, the Centers for Medicare & Medicaid Services (CMS) published a final rule which updated the Conditions for Coverage for OPOs. This change requires OPO’s performance to be measured by two new criteria:
- Donation rate measure
- Transplantation rate measure
Each OPO’s performance is benchmarked against other OPOs in the US. These organizations will be encouraged to meet donation and transplantation rates that were established from the previous 12-month period as the lowest rates of the top 25 percent of OPOs.
A Look to the Near Future
CMS will implement the new measures on August 1, 2022, which will initiate the enforcement of the new measures in the 2026 OPO certification cycle. These new measures will likely also impact hospital organ donation performance measures. It is likely that hospitals will begin to see revisions and redesigns in the data reported and presented to them by their OPO.
Strategies for Increasing Donation and Transplantation
While the measures are changing, hospitals, OPOs and transplant programs remain focused on seeking innovative and effective strategies to increase donation and transplantation. Reviewing the key strategies and the corresponding successful practices in a “Community of Practice Action Guide” (2011) provides valuable guidance for improvement.
The identified strategies for success are:
- Unrelenting Focus on Change, Improvement & Results
- Establish a strong culture of accountability for results
- Establish an active leadership & management support
- Integrate honoring donor designation into the goals of the organization.
- Establish protocols to honor donor designation every time.
- Utilize opportunities to recognize donors (donor flag, memorial areas.)
- Support donor families in real-time.
- Integrated Donation Process Management
- Catastrophic Brain Injury Guidelines (CBIG)
- Advocate donation as the mission
- Aggressive Pursuit of Every Donation Opportunity
- Advocate for donation
- Develop a Community of Practice Communication
- Intent – A culture of accountability for high yield (E/O/T every time)
- Culture: A community of practice in which all participants “walk the talk” the mission of achieving high procurement and transplant rates
- Empowering Infrastructure: Develop effective governance structures across the donation system
- Effective Relationships – A rapid response network responsible for donor management, organ recovery, and placement
- Cultivating Commitment
- Motivating Results
- Advanced Practice – Accountability for aggressive clinical care of the potential donor, the donor, and all eyes, organs and tissues
- Intensive Patient Care
- Identify and deploy advanced critical practice expertise for advanced clinical donor management, aggressive organ acceptance and recover