An important message from the MPSC on the implementation of the Offer Acceptance performance metric and other recommendations.

Published on: Friday, October 6, 2023

For the benefit of the transplant community, the OPTN Board has authorized the OPTN Membership and Professional Standards Committee (MPSC) to disseminate learnings and effective practices observed during MPSC meetings and interactions with OPTN members. Updates will be provided by the MPSC after each of their in-person meetings. 

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The Organ Procurement and Transplantation Network (OPTN) Membership and Professional Standards Committee (MPSC) recently communicated to a large segment of OPTN members about several recommendations and opportunities for improvement in processes and protocols related to organ recovery and transplant: 

• Implementation of Offer Acceptance performance metric  
• Focus on late declines with Allocation Review Subcommittee  
• Avoid last-minute procurement issues by double verifying resources  
• Document pre-transfusion or post-transfusion ABO determination in your records 

The MPSC is an operating committee of the OPTN Board of Directors. In addition to monitoring compliance with OPTN Final Rule, policies, and bylaws, the committee supports members through peer review and sharing of effective practices. Find the MPSC’s community updates and other materials on the MPSC resources page. 

Recently, the MPSC has started preparing for its first round of reviews for the transplant program offer acceptance metric, which was implemented in July 2023. The MPSC has also started work on: 

• The OPO Performance Monitoring Enhancements project, which is focused on taking a more holistic approach to evaluation of OPO performance. This project is closely tied to a recently created subcommittee that is focused on evaluating late declines
• Reviewing patient reports on ABO discrepancies and have found that most of these discrepancies occurred when ABO was determined post-transfusion

These are areas of focus where the MPSC believes it can provide valuable information and tools for opportunities for improvement, support and oversight.   

Implementation of Offer Acceptance performance metric 

With the implementation of the offer acceptance performance metric in July, transplant programs that are flagged for this metric have begun receiving inquiries on behalf of the MPSC. 

Listed below are some tools that the community can use to help understand their offer acceptance rate and implement effective practices for improvement: 

On the OPTN website: 

• Enhance Transplant Program Performance Monitoring Toolkit 
  • Effective Practices to Improve Offer Acceptance 
  • Offer Acceptance Collaborative Improvement Guide – provided to collaborative participants and will be available on the Collaborative Improvement projects page in the future     

In the Data Services Portal: 

• Organ Offer Data Family Table 
  • This resource is available under “Documentation” section, under the “Organ Offers/Match Runs” category and describes the time periods and information available in different visual analytics and data files that relate to organ offers

In the OPTN Learning Management System known as UNOS Connect: 

• Offer Acceptance Collaborative Playlist 
  • Playlist contains nine presentations that were part of the OPTN Offer Acceptance Collaborative, designed to support members and enhance system efficiencies through offer acceptance effective practices

New MPSC Transplant Metrics Dashboard    

This dashboard can be found in the OPTN Visual Analytics section of the Data Services Portal and allows transplant programs to: 

• Explore how subgroups impact their performance metrics
• View hazard ratios for 90-day and 1-year conditional on 90-day graft survival with data provided by the SRTR

Focus on Late Declines with Allocation Review Subcommittee 

The MPSC created a subcommittee to evaluate the observed increase in Allocations Out of Sequence (AOOS), specifically for livers and kidneys. The Subcommittee reviewed data and was not able to determine specific donor characteristics that make a kidney more likely to be allocated out of sequence. The Subcommittee is now focused on defining “late decline” and gathering information from transplant programs regarding characteristics of organs and reasons that contribute to late declines. 

This effort is tied closely with the work of the MPSC’s OPO Performance Monitoring Enhancement Workgroup. The MPSC is embarking on an effort to create a more holistic performance monitoring system for OPOs. The Workgroup is charged with initially focusing on defining standard processes and consistent definitions for essential data points for the “donor referral” to “donor authorization” phases of the donation process, and developing a proposal for new data collection. The OPTN currently collects a significant amount of data on donors and allocations but data on potential donor referrals to authorization is limited. The Workgroup had their first meeting in August and the following themes came out of their discussion: 

• Need for consistent data definitions and standardization during the referral through authorization phases
• Start data capture upstream – potential to work with the two main electronic donor record (EDR) vendors to create a widget
• Incorporate logic into the data capture process to guide OPO frontline staff to promote consistency. 
• Ensure processes are in place to make sure OPO staff are also capturing data correctly and consistently
• Consideration of collection of donor data from transplant hospitals to validate OPO data collection 

Avoid last-minute procurement issues by double verifying resources 

With changes in allocation and the increase in use of third-party organ procurement and placement organizations, the MPSC wanted to share some effective practices to avoid last-minute procurement issues that may arise. Some examples include: 

• Have a checklist of supplies and personnel needed for procurement, and double verify this checklist
• Communicate what is needed from the donor hospital in a timely manner
• Have clear roles and expectations of personnel
• Report any device malfunctions to the Food and Drug Administration (FDA)

Document pre-transfusion or post-transfusion ABO determination in your records 

The MPSC recently reviewed patient safety reports regarding ABO discrepancies and have found that most of these discrepancies occurred when ABO was determined from a post-transfusion blood sample. 

The MPSC urges members to clearly document in the record whether ABO was determined pre-transfusion or post-transfusion so the cause of any ABO discrepancy can be more quickly identified and so transplant programs can more fully evaluate the donor. The MPSC recommends OPOs document whether the donor’s ABO was determined pre- or post-transfusion is in the Donor Highlights section of OPTN Donor Data and Matching System. 

For questions or comments regarding this communication, please email MQFeedback@unos.org.