Post on 14-Jan-2016
description
Putting the Pieces Together: The National Donation and Transplantation Community of Practice
2009: Bringing the Pieces Together
• DSA Action Teams convened in January• Regional Collaborative Leaders• CEO Executive Summit• Pediatric Executive Summit• Donor Management Forum
• Local DSA Action• Regional Forums, Conference Calls• State Hospital Association Partnerships
Important Pieces of the Puzzle
• Making the pieces fit
– In your organization– In your DSA– In your Region– Among the 4 estates– With new DSA Partners
Potential Deceased
Donor Population
Potential Recipient
Populations
DonationDonor Management
Offer & Acceptance
Center Capacity
Wait List Management
Organs Transplanted
OPO and Donor Hospital
Three Estates
Transplant Centers Org
ans
Our National System
Pull
Push
Donor
Pat
ient
Our National Goals
• 35,000 deceased donor organs transplanted
• 75% conversion rate
• 3.75 organs transplanted per donor (OTPD)
• 10% DCD in all 58 DSAs
Deceased Donor Organs Transplanted
1999-2003
2004-2008
Change % Change
All Organs
Kidney
Pancreas
Liver
Heart
Lung
Intestine
Deceased Donor Organs Transplanted
1999-2003
2004-2008
Change % Change
All Organs
97,133 117,751
20,618 21.2%
Kidney
Pancreas
Liver
Heart
Lung
Intestine
Deceased Donor Organs Transplanted
1999-2003
2004-2008
Change % Change
All Organs
97,133 117,751
20,618 21.2%
Kidney 47,375 56,923 9,548 20.2%
Pancreas
6,849 7,083 234 3.4%
Liver 23,684 30,281 6,597 27.9%
Heart
Lung 7,697 11,611 3,914 50.9%
Intestine
480 870 390 81.3%
Deceased Donor Organs Transplanted
1999-2003
2004-2008
Change % Change
All Organs
97,133 117,751
20,618 21.2%
Kidney 47,375 56,923 9,548 20.2%
Pancreas
6,849 7,083 234 3.4%
Liver 23,684 30,281 6,597 27.9%
Heart 11,048 10,983 -65 -0.6%
Lung 7,697 11,611 3,914 50.9%
Intestine
480 870 390 81.3%
Steady Increases in Monthly Organs Transplanted
Organs Transplanted
0500
1000150020002500
JAN
02
MA
Y02
SE
P02
JAN
03
MA
Y03
SE
P03
JAN
04
MA
Y04
SE
P04
JAN
05
MA
Y05
SE
P05
JAN
06
MA
Y06
SE
P06
JAN
07
MA
Y07
SE
P07
JAN
08
MA
Y08
SE
P08
JAN
09
MA
Y09
Month/Year
Nu
mb
er
September 2003: 1800 organs
May 2009: 2100 organs
Target: 2900 organs
Increasing Capacity by 20%
Program Type # of Centers % Goal Met
Kidney 74 30
Liver 31 24
Heart 37 28
Pancreas 41 29
Lung 20 30
Intestine 5 23
All 66 25
Waiting List Deaths1999-2008
1999-2003 2004-2008
Kidney
Liver
PancreasKidney/Pancreas
Heart
Lung
Heart/Lung
Intestine
Waiting List Deaths1999-2008
1999-2003 2004-2008
Kidney
Liver 9,492 8,322
PancreasKidney/Pancreas
Heart 3,192 1,995
Lung 2,396 1,543
Heart/Lung 192 104
Intestine 226 224
Waiting List Deaths1999-2008
1999-2003 2004-2008
Kidney 17,664 21,690
Liver 9,492 8,322
Pancreas 204 326Kidney/Pancreas
1,014 1,032
Heart 3,192 1,995
Lung 2,396 1,543
Heart/Lung 192 104
Intestine 226 224
Total Deaths
Deaths/Year
1999 - 2003 2004 -2008
34,380 34,236
6,876 7,047
Deaths/Day 19 19
Waiting List Deaths1999-2008
System Measures:Five Defining Rates
2003 2008 2012
1. Conversion Rate 50% 71% 75%
2. % DCD 2% 10.6% 10%
3. % DMG 100%
4. OTPD 3.06 3.00 3.75
5. % Capacity ≥ 20%
Conversion Rate
• National Goal:
– 75% Collaborative Conversion Rate• (All Donors) / (Eligible) * 100
Conversion Rate Goal
• SCD: Standard Criteria Donors - an individual whose organs are donated after his or her death
• DCD: Donation after Cardiac Death - donors whose hearts have irreversibly stopped beating
• ECD: Expanded Criteria Donors - deceased donor over the age of 60 years; or from a donor over the age of 50 years with two of the following: a history of hypertension, a terminal serum creatinine greater than or equal to 1.5 mg/dl, or death resulting from a cerebral vascular accident (stroke)
Types of Donors
Organ Donor Increases1999-2003 v 2004-2008
Total Donors
SCD Donors
DCD Donors
ECD Donors
1999-2003
2004-2008
Change
% Change
Organ Donor Increases1999-2003 v 2004-2008
Total Donors
SCD Donors
DCD Donors
ECD Donors
1999-2003
30,538
2004-2008
38,831
Change 8,293
% Change
27.2%
Organ Donor Increases1999-2003 v 2004-2008
Total Donors
SCD Donors
DCD Donors
ECD Donors
1999-2003
30,538 23,079 829 6,628
2004-2008
38,831 26,056 3,236 9,539
Change 8,293 2,977 2,407 2,911
% Change
27.2% 12.9% 290.3% 43.9%
Monthly Conversion Rate Nearing 75% Goal
Collaborative Conversion Rate
35.0
45.0
55.0
65.0
75.0
JAN
02
MA
Y0
2
SE
P0
2
JAN
03
MA
Y0
3
SE
P0
3
JAN
04
MA
Y0
4
SE
P0
4
JAN
05
MA
Y0
5
SE
P0
5
JAN
06
MA
Y0
6
SE
P0
6
JAN
07
MA
Y0
7
SE
P0
7
JAN
08
MA
Y0
8
SE
P0
8
JAN
09
MA
Y0
9
Month/Year
Ra
te
22 of 58 DSAs at 75% for a continuous 12-month period
Organs Transplanted Per Donor
OTPD
Organs Transplanted per Donor
All Donors
3.75
DCD2.75
ECD2.5
SCD4.3
1999-2003
2004-2008
% Change
Organs Transplanted per Donor
All Donors
3.75
DCD2.75
ECD2.5
SCD4.3
1999-2003
3.18
2004-2008
3.03
% Change
-4.67%
Organs Transplanted per Donor
All Donors
3.75
DCD2.75
ECD2.5
SCD4.3
1999-2003
3.18 2.00 1.83 3.61
2004-2008
3.03 1.99 1.78 3.62
% Change
-4.67% -0.78% -2.27% 0.18%
DSAs Mobilizing for OTPD Breakthrough
1.502.002.503.003.504.004.50
JAN
02
MA
Y0
2
SE
P0
2
JAN
03
MA
Y0
3
SE
P0
3
JAN
04
MA
Y0
4
SE
P0
4
JAN
05
MA
Y0
5
SE
P0
5
JAN
06
MA
Y0
6
SE
P0
6
JAN
07
MA
Y0
7
SE
P0
7
JAN
08
MA
Y0
8
SE
P0
8
JAN
09
MA
Y0
9
Nu
mb
er
Month/Year
Organs Transplanted Per DonorGoal 3.75
Only one DSA has achieved 3.75 for 12 continuous monthsSCD OTPD 2008: 3.80SCD OTPD 2009: 4.56
DSAs at 3.75 or higher for Standard Criteria Donors
SCD Organs Tx Per Donor
July 2007- June 2008
July 2008- June 2009
3.75 18 22
4.0 1 9
Donation After Cardiac Death
DCD
Organ Donor Increases1999-2003 v 2004-2008
Total Donors
SCD Donors
DCD Donors
ECD Donors
1999-2003
30,538 23,079 829 6,628
2004-2008
38,831 26,056 3,236 9,539
Change 8,293 2,977 2,407 2,911
% Change
27.2% 12.9% 290.3% 43.9%
Sustained Increases in DCD
Percent of Donors From DCDs
0.02.04.06.08.0
10.012.014.0
JAN
02
MA
Y02
SE
P02
JAN
03
MA
Y03
SE
P03
JAN
04
MA
Y04
SE
P04
JAN
05
MA
Y05
SE
P05
JAN
06
MA
Y06
SE
P06
JAN
07
MA
Y07
SE
P07
JAN
08
MA
Y08
SE
P08
JAN
09
MA
Y09
Month/Year
Per
cen
t
28 of 58 DSAs meet the 10% Goal9 additional DSAs at 7-9%
Sustained Increases in DCD
Percent of Donors From DCDs
0.02.04.06.08.0
10.012.014.0
JAN
02
MA
Y02
SE
P02
JAN
03
MA
Y03
SE
P03
JAN
04
MA
Y04
SE
P04
JAN
05
MA
Y05
SE
P05
JAN
06
MA
Y06
SE
P06
JAN
07
MA
Y07
SE
P07
JAN
08
MA
Y08
SE
P08
JAN
09
MA
Y09
Month/Year
Per
cen
t
28 of 58 DSAs meet the 10% Goal9 additional DSAs at 7-9%
>4700 organs txIn 2004-2008
Our Progress in the Largest Hospitals
• 400 Hospitals
• 8+ Hospitals: 8 or more eligible deaths
• Sub-groups:– Top 50 Hospitals: 29-92 eligible deaths– Remaining Hospitals: 8-28 eligible deaths
Larger Hospitals Meet Goals Less Frequently
0%10%20%30%40%50%60%70%80%90%
100%
Top 50 8+
Conversion Rate OTPD DCD
Pediatric Transplantation
1999-2003 2004-2008
Transplants 5970 7643
WL Deaths 1543 1013
Deaths/Tx 1:3.87 1:7.54
Deaths/Day .85 .56
Take Away Messages
• Increase heart and kidney availability • Monthly conversion rate nearing 75% - but don’t
lose sight of imminent deaths and non-declared patients
• 37 DSAs meet or close to DCD goal - transparency for DCD vs DBD is essential
• OTPD unchanged but progress in some DSAs• Review donation systems in large hospitals• Renew focus in all 8+ hospitals• Help transplant programs meet 20% goal