Executive Summary

There is a perception in the transplant community that the OPTN's current method for monitoring transplant program outcomes has contributed to members’ increasingly conservative behavior. Specifically, in order to avoid being reviewed for transplant outcomes performance, members are reportedly overly selective in patients they will list for transplant and the organs they will accept to transplant. This proposal aims to change this perception and associated behavior by modifying the system the OPTN uses to monitor and review transplant program outcomes for each organ type (excluding vascular composite allografts). The proposed system entails four tiers: the highest tier identifies programs with high hazard ratios that will initiate automatic Membership and Professional Standards Committee (MPSC) review; the middle two tiers represent routine, quality improvement program reviews and include a random selection component (50% and 10% probability, respectively, of MPSC review) for all other programs with worse than expected post-transplant outcomes; and the bottom tier represents programs performing as expected or better that the MPSC will not engage in outcome reviews. Based on transplant programs’ 1-year graft survival and 1-year patient survival hazard ratios, programs will be placed in the tier that corresponds with the worse result of these two analyses.

The top tier in this proposed system, which prompts automatic MPSC review, is defined by a higher hazard ratio threshold than what is currently used. Due to an increased likelihood of transplant program underperformance at this higher hazard ratio threshold, programs identified in this tier will initially be requested to complete a more detailed and expansive survey than what is initially requested of programs currently identified for MPSC review. The middle two tiers of this proposed system, which include a random selection component for determining which programs the MPSC will review, reflect a validation of quality improvement efforts that are already being undertaken by transplant programs prior to MPSC involvement. A transplant program’s recognition of the issues that may have led to more events than what is expected, and the quality improvement efforts enacted to address those issues, will be a primary focus of the MPSC’s reviews that are prompted by the random selection of programs within these tiers. Programs that are able to demonstrate ongoing and appropriate quality improvement efforts will be released from further MPSC review.

Changing transplant programs’ perception of the OPTN’s outcome review system is intended to minimize the unintended consequence of increasingly conservative selection of patients and organs for transplant, thereby supporting the OPTN’s strategic plan goal to increase the number of transplants.

Read the full proposal. (PDF - 347 K)