HRSA Transplant Center Growth and Management Collaborative: Best Practices Evaluation Final Report - September 2007

The U.S. Department of Health and Human Services (HHS) has devoted considerable effort to achieving increased organ donation and transplantation rates by developing public awareness campaigns and identifying and replicating organ procurement organization (OPO), donor hospital, and transplant center best practices. Between 1995 and 2006, there was a 67percent increase in organ donors for all donor types from 8,854 to 14,756.¹³ During this time, organ transplants also increased from 19,393 to 28,932, an increase of over 49 percent.¹⁴ Combined, these data indicate an important upward trend in both organ donation and transplantation in the United States.

Despite this trend toward increased numbers of organ donors and transplants, a disparity remains between the demand for and supply of donor organs. Currently, there are more than 96,827 patients waiting for an organ transplantation in the United States.¹⁵ Further, of those on the waiting list, each day 79 will receive a life-saving organ transplantation, and 17 individuals die waiting.^{16, 17} Although there were over 4,500 organ donors and over 9,200 transplants between January and April of 2007, the gap between the supply of and demand for donor organs still remains.^{18, 19}

HHS’s Health Resources and Services Administration (HRSA) is committed to addressing this unmet need and has done so by implementing several initiatives. Two recent initiatives, the Organ Donation Breakthrough Collaborative and the Organ Transplantation Breakthrough Collaborative, have identified “breakthrough” best practices that are associated with increases in organ donation and transplantation in high-performing OPOs, hospitals, and transplant centers.^{20, 21} Together, the Organ Donation and Transplantation Breakthrough Collaboratives have resulted in an increase in the number of deceased donors and in organ availability. For example, in the 1st year of the Organ Donation Breakthrough Collaborative, organ donation increased by 10.8 percent in the United States.²² Other initiatives, such as The Workplace Partnership for Life, Strengthening Donor Registries, and the Driver’s Education Curriculum have also served to increase organ donation consent rates by educating the public about organ donation.

As these and other initiatives assist in increasing the supply of donor organs and the number of organs transplanted per donor, HRSA now seeks to identify and spread the best practices of transplant centers that are quickly adapting to the increased supply of donor organs by achieving high organ transplantation rates, while maintaining expected or higher than expected patient and graft survival outcomes. By identifying and spreading these best practices, HRSA intends to help transplant programs across the country effectively grow. An investigation into current and emerging practices that influence a transplant center’s ability to increase acceptance and transplantation rates of organs, while maintaining expected or higher than expected outcomes can significantly improve the number of successful transplants performed in the United States.

This report presents observations of the best practices of selected high-performing transplant centers that have achieved high organ transplantation rates and efficiency in recovered organ use, while maintaining expected or higher than expected patient and graft survival outcomes. Section II describes the study design and methodology, including site selection, data collection and synthesis, and study limitations. Sections III-VIII present the study findings, grouped by the six strategies/drivers of the Change Package Document (see Appendix A). The strategies/drivers represent the best practices associated with high performance in organ acceptance, transplantation, and outcomes identified on the site visits to 15 high-performing transplant centers. Each of these sections includes a description of the key change concepts and action items that correspond with the strategy/driver, as well as examples of how the action items are being implemented at 15 transplant centers across the country. Section IX discusses implementation considerations for the six strategies/drivers, and Section X presents the conclusion of the report.

¹³Donors recovered in US by donor type. Richmond, VA: Organ Procurement and Transplantation Network (not a U.S. Government Web site), 2007. Accessed July 9, 2007.
¹⁴Transplant by Donor Type. Richmond, VA: Organ Procurement and Transplantation Network (not a U.S. Government Web site), 2007. Accessed July 9, 2007.
¹⁵Waiting List Candidates. Richmond, VA: Organ Procurement and Transplantation Network (not a U.S. Government Web site), 2007. Accessed July 9, 2007.
¹⁶Transplants by Donor Type. Richmond, VA: Organ Procurement and Transplantation Network (not a U.S. Government Web site), 2007. Accessed July 9, 2007.
¹⁷Removal Reasons by Year. Richmond, VA: Organ Procurement and Transplantation Network (not a U.S. Government Web site), 2007. Accessed July 9, 2007. http://www.optn.org/latestData/rptData.asp.
¹⁸Donors recovered in US by donor type. Richmond, VA: Organ Procurement and Transplantation Network (not a U.S. Government Web site), 2007. Accessed July 9, 2007.
¹⁹Transplant by Donor Type. Richmond, VA: Organ Procurement and Transplantation Network (not a U.S. Government Web site), 2007. Accessed July 9, 2007.
²⁰The Organ Donation Breakthrough Collaborative: Best Practices. The Lewin Group, 2003
²¹The Organ Transplantation Breakthrough Collaborative: Best Practices Evaluation. The Lewin Group, 2005.
²²Burdick, J. Memo to ASTS membership: Organ Transplantation Breakthrough Collaborative. Health Resources and Services Administration, June 17, 2005. Accessed July 19, 2006.