Goal 1

Increase the number of transplants

Goal 1 includes continuing efforts to improve performance metrics, moving from one or two indicators to a more comprehensive dashboard approach. It also includes tools to improve utilization and increase system efficiency. It also calls on the OPTN to explore ways to increase the use of donation after cardiac death (DCD) organs for transplant, and to review policies to determine whether any changes are necessary to facilitate emerging organ perfusion technologies.

Resource allocation benchmark: 50%

Core activities

Serving as the Organ Procurement and Transplantation Network (OPTN), UNOS maintains the national transplant candidate waiting list and operates a 24/7 electronic matching system accessible to every Organ Procurement Organization (OPO) and transplant hospital in the country. UNOS also operates a 24/7 Organ Center, a live call center to assist OPOs and transplant hospitals with questions, transportation arrangements, and with placing organs.

Initiatives

1. Improve metrics and monitoring approaches for increased collaboration and performance improvement activities when assessing transplant program and OPO performance.
   • Develop improved OPO metrics that provide an accurate assessment of OPO performance and can be leveraged as a tool to identify actionable improvement opportunities.
   • Develop a dashboard of transplant hospital metrics that goes beyond one-year post-transplant outcomes and avoids creating disincentives to transplant, to include measures that can be utilized to identify strategies for improvement, including monitoring of offer acceptance rates by donor age and donor type, and late declines for candidates with multiple accepted offers.
     • Include metrics that measure quality of life for transplant recipients.
     • Include metrics for multi-organ transplants.
   • Develop systemic metrics that measure the interactions between OPOs and transplant hospitals that identifies opportunities to increase the number of transplants.
2. Pursue policies and system tools that promote system efficiency and increase organ utilization.
   • Expand the use of offer filters to reduce unwanted offers and increase efficient placement.
   • Reform the use of the “provisional yes” to make it a timely, meaningful response.
   • Address wide variation in biopsy practices.
   • Expedite offers of difficult to place organs.
   • Increase seamless data exchange between members and UNet^SM to reduce data burden and improve data integrity.
   • Support the use of local recovery to increase utilization and reduce team travel.
     • Improve technology support for sharing images and information during recovery process.
     • Develop best practices to work towards consistent expectations for local recovery.
3. Increase the number of Donation after Circulatory Death (DCD) donor organs recovered and transplanted by encouraging inter-organ and inter-program collaboration and the development of effective practices, particularly in the area of heart transplantation, where DCD organs have been historically underutilized.
4. Review policies to determine whether future changes will be necessary to encourage or facilitate mechanical preservation during transportation of organs.
5. Increase living donation.
   • Increase the effectiveness of paired living donation programs.
     • Develop policies to allow deceased donor kidneys to begin kidney paired donation (KPD) chains.
   • Increase education about living donor safety, recipient outcomes, and available support.
6. Conduct donor management research to improve practices.

Key Metrics

1. A decrease in time from first organ offer and average number of offers to acceptance.
2. An increase in national offer acceptance rates.
3. A decrease in the number of candidates that die on the waitlist who had received an offer of an organ that was transplanted.
4. An increase in utilization rate of organs from older donors.
5. An increase in utilization of organs from participants in collaborative improvement programs.
6. An increase in the utilization rate of DCD donor organs.
7. An increase in the number of transplants of mechanically preserved organs.
8. An increase in transplants performed through kidney paired donation.