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

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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

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Month/Year

Ra

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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

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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

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Month/Year

Per

cen

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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

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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