Direct Measurement of Organ Procurement Organization Donor Potential Using Comprehensive Referral Analysis: Feasibility and Implications for Assessing Organ Procurement Organization Performance

BACKGROUND: Previous methods for assessing organ procurement organization (OPO) performance have not been reliable, making it necessary to develop a direct measurement of donation service area donor potential. The purpose of this study was to use a previously validated direct measurement of donor potential using referral data from 6 US OPOs to assess its usability as an alternative to current methods. METHODS: Records of all 45 458 potential organ donors referred to 6 US OPOs in 2023, based on Medicare requirements of hospital referral, were reviewed; reasons that cases did not proceed to donation were categorized and quantified. All hospital deaths were reviewed through tissue referrals and chart audits to assess whether potential organ donors had not been referred. RESULTS: Of the 45 458 referrals, 40 978 cases were ruled out for documented clinical reasons, leaving 4480 medically suitable potential donors. The percentage of medically suitable referrals by OPO varied from 7.5% to 12.4%. Hospitals referred to >99% of the medically suitable potential donors. A review of a large number of referral records was made possible by robust electronic systems in each OPO, which also makes auditing practical. CONCLUSIONS: Determining OPO donor potential directly from a comprehensive analysis of hospital referrals is feasible and can be validated across multiple OPOs. It is more accurate than measures that use administrative data sources and could be a suitable alternative. Efforts should be made by national organizations to further their development.