New transplant performance metric now in effect, pre-transplant mortality rate ratio
Published on: Monday, August 5, 2024
A new risk-adjusted transplant performance monitoring metric, the pre-transplant mortality rate ratio, went into effect on July 25, 2024. The OPTN Membership and Professional Standards Committee (MPSC) recognizes that a patient’s goal is to gain access to transplant, not just to a program’s waiting list. The pre-transplant mortality rate metric aims to increase the likelihood that a patient makes it to transplant by encouraging improved waiting list management activities and incentivizing more aggressive offer acceptance practices.
What does the pre-transplant mortality rate ratio consider?
The pre-transplant mortality rate ratio indicates whether patients listed at a program are more or less likely to die prior to receiving a transplant than expected.
This risk-adjusted metric compares a transplant program’s observed pre-transplant mortality rate to its expected pre-transplant mortality rate, based on mortality of patients with similar characteristics and length of time on the waiting list across the nation.
This metric is risk-adjusted for candidate characteristics and time on the waiting list. For more information on risk adjustment and the Scientific Registry of Transplant Recipients (SRTR) models developed for the MPSC performance evaluation metrics:
- A presentation titled “MPSC: Enhance Transplant Program Performance Monitoring System: Proposed Metrics” may be viewed here.
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- This video addresses frequently asked questions. There are also additional resources on the SRTR website on risk adjustment.
- A policy toolkit has more information and resources for transplant professionals about the new system, including policy documents and education.
What patients are included?
- Patients listed at a program before the end of the evaluation interval
- Patients listed at a program at the beginning of the evaluation interval
What happens next?
Inquiries will be sent to transplant programs based on MPSC evaluation of SRTR reports for program performance on mortality for candidates appearing on the waiting list at any time during the period of January 2022 through December 2023. Read the OPTN policy notice.
Background
The OPTN Board of Directors approved revised bylaws for transplant program performance monitoring on Dec. 6, 2021. The approved bylaws include four new metrics for evaluation of transplant program performance:
- 90-day post-transplant graft survival hazard ratio and one-year post-transplant graft survival conditional on 90-day graft survival hazard ratio – implemented July 14, 2022
- Offer acceptance rate ratio – implemented July 27, 2023
- Pre-transplant-waiting mortality rate ratio- implemented July 25, 2024
Questions?
We understand you may have questions about these changes and are glad to provide any information you need as the community adjusts to the implementation of the new performance metrics.
Please contact us at MPSCReports@unos.org