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National Deceased Donor Potential Study: Updates and Next Steps

National Deceased Donor Potential Study: Updates and Next Steps. Karl J. McCleary, Ph.D., M.P.H., Scientific Director, CTSE Principal Investigator, DDPS Affiliate Faculty, School of Medicine, Virginia Commonwealth University.

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National Deceased Donor Potential Study: Updates and Next Steps

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  1. National Deceased Donor Potential Study: Updates and Next Steps Karl J. McCleary, Ph.D., M.P.H., Scientific Director, CTSE Principal Investigator, DDPS Affiliate Faculty, School of Medicine, Virginia Commonwealth University Acknowledgement: The Deceased Donor Potential Study is a commissioned study funded by the Organ Procurement and Transplantation Network (OPTN) under Task 6 of the existing contract. The OPTN is supported by Health Resources and Services Administration (HRSA), Healthcare Systems Bureau, Division of Transplantation’s contract #234-2005-370011C. The content described here is the responsibility of the author alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, the OPTN, or UNOS; nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

  2. The “Question” • What is the “true” potential for deceased organ donation in the United States?

  3. Purpose of Study • The DDPS aims to generate more current scientific evidence that is based on rigorous epidemiologic, population, demographic, and geographic analyses of the deceased donor system for the purposes of determining the potential number of organ donors, and to determine the potential trend in that number over time.

  4. Specific Aims: Objectives

  5. Research Strategy • Build a unifying framework for understanding deceased donor potential, linking existing bodies of knowledge and specific research traditions that are relevant to transplantation withthe power of transdisciplinary science approach. • Examine deceased donor potential from a complex system view.

  6. Important Qualifiers or Clarifying Points about the Study • What the study is not: • Does not include OPTN policy formation and analysis. • Does not include any focus on organ allocation or distribution. • Does not include any recommendations on differing geographic units of measure or operational approaches. • Study is not focused on current understandings or classifications typically used for compliance reasons (ECD, SCD, etc.).

  7. Deceased Donor Potential Study: 3 Threads

  8. DDPS : Expert Group that Informs this Work

  9. Deceased Donor Potential Study Subcommittee Contributions Caregiver Informant Group OPO Subcommittee Data Subcom System Dynamics Team Evidence-based Review Open Innovation

  10. Inside the Mortality Funnel: Path from All Deaths to Deceased Donors 3. Donors 1. All Deaths 2. All Medically Suitable Deaths Source: Adapted from T. Beigay, M. Reibel, & J. Rosendale, 2011. *Note: Graphic is not drawn to scale.

  11. Data source triangulation for Donor Potential Number • The CIG, OPO, and Data Subcommittees will collaborate to provide three different estimates of donor potential using different databases and similar filters • This range of estimates will also be used in the System Dynamics Deceased Donor Potential model

  12. Data Source Options

  13. Donor Potential Estimate #1 4. OPTN Donors 3. OPTN Database 2. All Medically Suitable Deaths 1. All Deaths Custom Criteria for Filter

  14. Donor Potential Estimates #2 & #3 Custom Criteria for Filter 4. OPTN Donors 3. OPTN Database 2. All Medically Suitable Deaths 1. All Deaths

  15. Proposed Procedure for Developing and Applying Custom Criteria for Medical Suitability for Deceased Donation Goal: Apply Custom Filters to Datasets Synthesize and Operationalize Criteria Within the Constraints of Available Data (Data Subcommittee) Criteria from OPO Leaders and Procurement Professionals (OPO Subcommittee) Criteria from Clinicians and Caregivers (CIG Subcommittee)

  16. Donor Potential Gap Analysis: Actual v. Potential • Build comprehensive dataset (includes NCHS and California’s Death Statistical Master files match-merged with OPTN Deceased Donor data + Census data) • Conduct comparative donor gap analyses • Use logistic regression models to determine probability of • Donation if eligible • OPTN Database - if medically suitable • OPTN Donor- if medically suitable 4. OPTN Donors Gap 1 Gap 2 3. OPTN Database 2. All Medically Suitable Deaths 1. All Deaths Gap 3

  17. Donor Policy Projections • What policies are most effective to increase donation and increase realization of deceased donor potential? What if … Validation/ calibration Successful Transplants per year

  18. Updates

  19. Key Milestones

  20. Next Steps and Actions

  21. July July/August September 2012

  22. Acknowledgements

  23. The Stakeholder Committee

  24. The Research Team

  25. Center for TransplantSystem Excellence Improving the care continuum

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