Organ and Tissue Donation – 2013 and Beyond Teresa Shafer, RN, MSN, CPTC Executive Vice President and Chief Operating Officer

Organ and Tissue Donation – 2013 and

Beyond

Teresa Shafer, RN, MSN, CPTC

Executive Vice President and Chief Operating Officer

Click to edit Master subtitle style

Presentation Overview

• Sketch of Types of Donation – Frame up our System

• Controversial Metrics

• Donor Potential

• Questions

Organ Donation System and Process


Currently…

• Types of donation• Organ – Heart, Lung, Liver, Pancreas, Kidney,

Intestine• Tissue – Bone, Ligaments, Tendons, Saphenous

Veins, Heart Valves, Skin• Corneas/Eyes

• Types of donors• Brain-dead, heart-beating• Non-heart-beating (Donation after Cardiac Death,

DCD)• Living, related or unrelated


Pathways to Donation

BRAIN DEATH Patient maintained on

ventilator, heart beating Potential organ & tissue

donor Tissue recovery follows

organ donation

DCD Family initiates

withdrawal of care Patient likely to arrest

within 60 minutes of extubation

CARDIAC DEATH Patient has no cardiac

or respiratory activity. Potential tissue donor Body must be kept cool

before tissues are recovered.

Recovery is within 24 hours of death


Currently…

• Roughly 28,500 organs transplanted yearly in U.S. (22,000 from deceased donors, 6,500 from living donors)

• Approximately 750,000 tissues transplanted yearly in U.S.

• Approximately 45,000 corneas transplanted yearly in U.S.

Current Challenges


Major Challenges

• Limited supply of brain dead organ donors (estimated 12,000 nationally per year)

• Demand for transplants growing faster than supply of organs

• Early deceleration of care, DNI, DNR, improved trauma care, etc shrinking number of potential brain dead organ donors

• Aging population means more “extended criteria” organs


National Health Crisis

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

20000

40000

60000

80000

100000

Living DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving DonorsLiving Donors

Waiting recipients Transplants Living DonorsCadaveric Donors

Transplanted Pa-tients

Waiting ListORGAN SHORTAGE!

DeceasedDonors

LivingDonors


108,000 People Waiting - 150% of the average NFL Stadium


Overall donation rates (per 100 eligible deaths), by DSA

HRSA SRTR. http://srtr.transplant.hrsa.gov/annual_reports/2011/ The SRTR is administered by the Chronic Disease Research Group of the Minneapolis Medical Research Foundation, with oversight and funding from the Health Resources and Services Administration.

CY 2011

http://srtr.transplant.hrsa.gov/annual_reports/2011/


Organs transplanted per donor (OTPD), by DSA

CY 2011

HRSA SRTR. http://srtr.transplant.hrsa.gov/annual_reports/2011/ The SRTR is administered by the Chronic Disease Research Group of the Minneapolis Medical Research Foundation, with oversight and funding from the Health Resources and Services Administration.

http://srtr.transplant.hrsa.gov/annual_reports/2011/


Variation in the use of ECD donors in 2011, by DSA


Variation in the use of DCD donors in 2011, by DSA


Variation in Waiting Time (months)for Deceased Transplant, 2011


Variation in Waiting Time (months)Heart and Lungs, 2011

Every Organ Every Time…….Where is the Case for OPO Volume?

And what happens to OTPD, if we do make that case?

Teresa Shafer, RN, MSN, CPTC

Executive Vice President and Chief Operating Officer


Single Organ Donors –a match for a single recipient….

• The decision as to whether or not to recover a single organ from a single donor should not be driven by its effect on OPO OTPD.

• The decision as to whether or not to recover a single organ from a single donor should not be driven by financial consideration.


2003 2004 2005 2006 2007 2008 2009 2010 20110

1000

2000

3000

4000

5000

6000

7000

8000

9000Organ Donors

flat

Organ Donors2003-2011

24% increase in organ donors, 2003 – 20071% increase in organ donors from 2007 - 2010

DHHS. OPTN. Collaborative Scorecard. Data for Period: September 2009 – August 2010. https:www.healthcarecommunities.org


2003 2004 2005 2006 2007 2008 2009200,000,000

220,000,000

240,000,000

260,000,000

280,000,000

300,000,000

320,000,000Population

US Population2003-2010

6% increase in population, 2003 – 2009

http://www.census.gov/popest/states/NST-ann-est.html




2003 2004 2005 2006 2007 2008 2009 2010 20110

2000

4000

6000

8000

10000

12000Reported Eligibles

20% DECREASE in Reported Eligible Donors

Reported Eligible Donors2003-2011



2003 2004 2005 2006 2007 2008 2009 2010 20110.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Conversion Rate

52% INCREASE in Conversion Rate

Conversion Rate2003-2011



2003 2004 2005 2006 2007 2008 2009 20100

5

10

15

20

25

30Donors per Million

Donors per Million2003-2010

25% increase in d.p.m., 2003 – 2010

Donor Data from: DHHS. OPTN. Collaborative Scorecard. Data for Period: September 2009 – August 2010. https:www.healthcarecommunities.orgPopulation data from www.aopo.org. AOPO Documents>AOPO Monthly Profile Survey Data

http://www.aopo.org/


2003 2004 2005 2006 2007 2008 2009 20100

1000

2000

3000

4000

5000

6000

7000

8000

9000

0

5

10

15

20

25

30Organ Donors and Donors per Million

Donors donor per million

Donors & donors per million2003-2010

24% increase in organ donors25% increase in donors per million

Donors per M

illion

Organ D

onors



2003 2004 2005 2006 2007 2008 2009 20100

2000

4000

6000

8000

10000

12000

0%

10%

20%

30%

40%

50%

60%

70%

80%

Eligibles and Conversion Rate

Eligibles Conversion Rate

52% INCREASE in Conversion Rate20% DECREASE in Eligibles

Decreasing Eligibles and Increasing Conversion Rate

Eligible D

onors

Conversion

Rate



2003 2004 2005 2006 2007 2008 2009 2010 20110

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

0%

10%

20%

30%

40%

50%

60%

70%

80%Organ Donors and Conversion Rate

Donors Conversion Rate

Donors & Conversion Rate2003-2011

25% increase in organ donors52% increase in conversion rate

Conversion R

ate

Organ D

onors



Decreasing OTPD with donor volume (measured in dpm)

15.0 20.0 25.0 30.0 35.0 40.02.0

2.2

2.4

2.6

2.8

3.0

3.2

3.4

Donors per Million

OTPDLinear (OTPD)

OT

PD



Eligible Donors do not represent the donor pool

• Conversion rate with reported eligibles as denominator are not reliable inter-OPO (between OPOs) performance comparison metric.

• Conversion rate intra-OPO (within OPO) are useful to that OPO to observe current conversion rate against historical conversion rates, given that the OPO did not change its own definitions or measurement strategies.

• Reported Eligibles do not represent the U.S. donor pool, but we behave as if they do……• While there are other problems with the eligible

definition, the first step in the wrong direction was excluding donors from the pool who were not officially pronounced dead…..


2003 2004 2005 2006 2007 2008 2009 2010 20110

2000

4000

6000

8000

10000

0%10%20%30%40%50%60%70%80%Organ Donors and Conversion Rate

Donors Conversion Rate

An Unsustainable Trend & a need for Renewed Focus

25% increase in organ donors52% increase in conversion rate

Conversion R

ate

Organ D

onors

This is the trend that is not sustainable,- for our patients or for our credibility…….. We can’t transplant conversion rate, we can only transplant organs, and sadly, a volume metric is missing from the CMS Outcome Measures.You get more of what you measure…….and there is no volume metric in the CMS outcome measures…….

LifeGiftMetrics

Jan – July, 2013


Conversion Rate & PotentialJan – July, 2013 compared to 2012

2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

193 155

51 62

Donors No Authorization

Conversion Rate of 71.4% in 2013, compared to a conversion rate of 79% in 2012.

Applying same conversion rate to 2013 potential would yield 17 donors – 16 more donors for 2013.

Conversion Rate: 9.6% decrease

Donor Potential: 11% decrease

79%71.4%


AA Consent Rate; African American Donors

West North Southeast TOTAL0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

50%45%

65%59%

85%

66%71%

20122013

1 811 1523 34 24

January – June 2013

No AA potential donors in 2012


Hispanic Consent Rate;Hispanic Donors


10%

20%

30%

40%

50%

60%

70%

80%

90%

60%

73%

81%77%

50%

60% 60%57%

20122013

3 311 1826 40 243



Caucasian Consent Rate; Caucasian Donors


20%

40%

60%

80%

100%

120%

100%

80%

88% 86%

100%

81%88% 86%

20122013

6 2632 3526 92 679



OPO Productivity – VOLUMETotal Organ Donors

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TOSA

DTCP Monthly UNOS data reports; most recent time period for Collaborative Scorecard through April as of July, 2013


OPO Productivity – VOLUMETotal Organs Transplanted

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STA

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TOSA

New England



OPPORTUNITY COST

There is opportunity cost but there is great potential in recovering non-traditional donors.

Everyone should have the opportunity to donate.

Every withdrawal of life support and ventilatory support should be evaluated and given the opportunity to donate. Presumptive – presume death will occur in time frame suitable for donation.

POTENTIAL – NON TRADITIONAL DONORS


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TOTAL DONORS

Based on OPTN Data as of May 24, 2013

Of approximately 6000 acute care hospitals in US, 2265 had atleast one organ donor during this period.


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DCD Donors


DCD Donors – LifeGift Hospitals2009 - 2012

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575 Hospitals

had atleast 1 Pediatric Donor in 2009 – 2012.

These are the

nation’s largest

Pediatric Organ Donor

Hospitals


Pediatric Donors


Top Pediatric Hospitals - DCD 2009 - 2012

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Pediatric DCD Donors


OPTN Deceased Donor Potential Study:

Background, Early Findings and Commentary


DDPS Research Team

NAME & ORGANIZATIONAL AFFILIATIONFUNCTIONAL ROLE ON TEAM

Karl J. McCleary, PhD, MPH (UNOS CTSE & VCU) Principal Investigator

Gary B. Hirsch, MS (MIT) Co-Principal Investigator

L. Ebony Boulware, MD, MPH Co-Investigator

Leah B. Edwards, PhD (UNOS Research) Co-Investigator

Gary King, PhD, MA (Harvard) Co-Investigator

Kevin A. Myer, MSHA (UNOS CTSE) Co-Investigator

Michael Reibel, PhD (Cal Poly) Co-Investigator

John D. Rosendale, MS (UNOS Research) Co-Investigator

Khalid Saeed, PhD, M. Eng. (WPI) Co-Investigator

Laura A. Siminoff, PhD, MA (VCU) Co-Investigator

Samuel Soret, PhD, MPH (Loma Linda U) Co-Investigator

Kirstina Wile, MS (Systems Thinking Collaborative) Facilitator

Joyce DK Essien, MD, MBA (Emory; CDC; Retired) Facilitator




Future Directions


Percentage of Population > 18Registered Donors in Texas

2013

2012

2011

2010

2009

2006-2008

0% 5% 10% 15% 20% 25%

23.5%

17%

12%

7%

2%

1%


Where do we stand?

Room for improvement…and gaining quickly

Registrants > 18 y/o

TX 4,479,800 19,073,564 23.5%

FL 7,348,607 15,315,088 47.9%

CA 10,499,913 28,801,211 36.5%

NY 3,320,000* 15,307,107 21.5%

Click to edit Master subtitle styleState DD

CA 9,954,273

FL 7,075,534

IL 5,257,313

OH 5,213,582

PA 4,484,705

GA 4,419,720

NC 4,347,096

WA 4,161,910

VA 3,615,938

TX 3,612,525

State DD

IN 3,448,333

NY 3,179,754

MO 3,109,700

MI 3,088,837

MA 2,690,667

CO 2,650,000

WI 2,557,891

MN 2,541,433

MD 2,403,255

NJ 2,379,141

To 10th and climbing quickly…Total Donor Designations, as of 3/31/13

*Estimated


Future Directions

• Increased number of donors coming from “first person consent” or registries

• Increased consent/conversion• Increased success utilizing older donor

organs• Increased utilization of “donation after

cardiac death” donors


Questions?

1. What are the different types of donors that can donate vascular organs for transplantation?

2. Approximately how many organ donors are recovered each year in the U.S.?

3. What are Hispanic and African American Authorization Rates in the LifeGift community?

4. Does registration on the Texas Donate Life Registry constitute a valid and binding donation authorization?


Questions?

Question 1:What are the different types of donors that can donatevascular organs for transplantation?

1. Brain dead donors2. DCD (Donation after Cardiac Death)3. Living Donors4. All the above


Questions?

Question 2Approximately how many organ donors are recoveredeach year in the U.S.?

1. 5,0002. 8,0003. 10,0004. 15,000


Questions?

Question 3What are Hispanic and African American Authorization Rates in the LifeGift community?

1. 50 – 60% Hispanic and African American Living Donors2. 20 – 30% Hispanic and African American Living Donors3. 10 – 20% Hispanic and African American Living Donors4. 70 – 80% Hispanic and African American Living Donors


Questions?

Question 4Does registration on the Texas Donate Life Registry constitute a valid and binding donation authorization?

1. No2. Yes3. Maybe4. Unknown

THE END