Insight Series

How can transplant centers improve their offer acceptance habits?

Five Opportunities to Improve Offer Acceptance

1. Learn about available resources
   • Understand the tools available to you and develop a plan to utilize them
   • Select only those tools most helpful for your organization and use consistently
   • Attend UNOS CARE User Group meetings to get ideas from other programs on how they are approaching the use of various tools

2. Look at your data and look at it frequently!
   • SRTR secure monthly site monthly “across donor characteristics“ table
   • Trend over time
   • Create an offer declined meeting to continually review your data

3. Examine current offer acceptance habits and determine opportunities for improvement
   • Be realistic about what your center will or will not accept
   • Do a review of current offer acceptance, policies and protocols
   • Create an offer declined meeting to continually review your data

4. Understand current practices around standard listing criteria and impact on whitelist
   • Review standard listing criteria and make sure physicians know where this is being documented in UNOS
   • Especially with a large waitlist – standard listing criteria can lead to a lot of offer declines
   • Offer acceptance is not equal to organ acceptance. All unique candidates who are offered and declined will count towards the metric
   • By setting these criteria to the requirements for a specific patient, a transplant program, illuminates offers they would not accept for that specific patient. This reduces the number of declines impacting a transplant program

5. Look for opportunities to increase offer acceptance in certain categories
   • Waitlist review > not all candidates are going to accept all kinds of organs
   • Examine categories, such as PHS, DCD, HCV, KDPI, donor age/location to identify good candidates for a hot list of patients willing to accept these donor organs

Background

Breakdown of elements being reported

How do I know how my center is currently doing?

What OPTN and UNOS tools are available to assist in improving offer acceptance?

OPTN ROO Report

To allow for the review of all offers to patients at your program during the past 180 days. It is the best tool to understand the total volume of offers being managed by your program, as well as understand the cases where a bypass occurred.  The weekly data are available as both an Excel spreadsheet of the raw data in the OPTN Data Files section of the Data Service portal (DSP), as well as in a Tableau dashboard (Figure 7) within the OPTN Visual Analytics section.

Figure 7: OPTN Organ Offers Report TXC/ROO Report

UNOS Care Tool

To see data on the graft and patient outcomes of organs refused by your program and transplanted elsewhere.  This data can help programs broaden the acceptance of specific types of organs and identify opportunities to transplant more organs without impacting outcomes.  The tool (Figures 8-9) is available to all UNOS member transplant hospitals and is found in the UNOS Visual Analytics section of the DSP.  The report includes a review of all primary offers received by the transplant program during the past two years, excluding any matches not yet completed by the OPO, and is updated weekly.

Figure 8: CARE Tool Accept Tab

• Allows for filtering to only organs accepted and transplanted
• First visualization includes green bar of number of distinct donors offered during period, blue bar of number of those accepted by program, and red line of acceptance rate.
• Acceptance rate here is by donor offered to program, not individual patient offers.

Figure 9: CARE Tool OFFER Tab

• Filter to only organs declined by program but transplanted elsewhere
• Detailed data can be downloaded to Excel.
• Filter to specific donor or see all offers for a specified candidate during the period.
• Filter to individual refusal reasons.
• A unique feature is the ability to see the most recent outcomes reported by other transplanting programs on the TRR and six month/one-year TRFs.

OPTN Offer Filters for Kidney

The new OPTN Offer Filters tool allows transplant programs to provide more specific acceptance criteria for their program by allowing a combination of factors. For example, a hospital can indicate they wish to see offers of DCD organs, but only if they are under the age of 60 and if the donor is within 500 nautical miles of the transplant hospital and if the offer is prior to cross-clamp.  This allows a hospital to decrease the volume of unwanted offers needing to be managed by their staff and to potentially increase their acceptance rate depending on the expected acceptance for the excluded offers.     

In addition to this functionality, Offer Filters Explorer (Figure 10), found in the OPTN Visual Analytics section, applies Data Science techniques to historical data at each transplant program to identify recommended offer filters with the most potential impact on unwanted offers with few, if any, historically accepted organs impacted.  Offer Filters Explorer allows you to review the impact of potential filters on historical data. You must navigate to the Offer Filters Manager application to set the filters for future offers.

Figure 10: Offer Filters Explorer

How to access risk adjustment factors from the SRTR public website:

1. Go to public SRTR website (www.srtr.org)
2. Tools > Risk Adjustment Models > Offer Acceptance
3. Choose organ of interest and model strata > click on “Model Elements Plots” tab and then download .csv file.  This will show you which factors are risk adjusted for the candidate and donor, as well as the impact of each factor.

How to see most current offer acceptance habits on SRTR secure website:

1. Go to secure SRTR site (https://securesrtr.transplant.hrsa.gov/home/)
2. Reports > CUSUM Charts > Type: Offer acceptance
3. Time period of offers is at the top right of both CUSUM charts
4. “Across donor characteristics” table details overall offer acceptance ratio as well as the ratio for specific categories, including DCD, increased risk, and HCV+ offers

How to access OPTN ROO reports:

• Dashboard Tool

1. Go to Data Services Portal in UNet
2. OPTN Visual Analytics  > Organ Offers Report TXC
3. Select organ “Organ Accepted” and time period of interest “Month of Match”

• Excel Spreadsheet, download raw data file

1. Go to Data Services Portal in UNet
2. OPTN Data Files > Use Publication Title filter by typing “ROO” and hitting enter > Report of Organ Offers (ROO) > Click on report name to download file > Click on file name, should open in Excel

• Custom Report Builder

1. Custom Report Builder > New Report > Select Data Source of Organ Offers
2. Create your own report, documentation available in Documentation section of the Data Services Portal

• Enhance Transplant Program Performance Monitoring
• OPTN Enhanced Transplant Program Performance Metrics [PDF]
• Enhance Transplant Program Performance Monitoring System: OPTN Membership and Professional Standards Committee (MPSC) [PDF]

We would like to express our sincerest gratitude for our contributors’ tireless efforts on making Transplant Quality Corner a reality. Their dedication and expertise have been an invaluable contribution to the successful launch of this project. We are incredibly grateful for all their hard work and commitment.