UW Hospital and ClinicsOrgan Procurement Organization

(OPO)

Tony D’Alessandro, MDMedical Director, UWHC OPO

November 4, 2009

What is an OPO?

58 Federally Designated Organ Procurement Organizations (OPOs) in the United States

– Must be nonprofit organizations--

In Wisconsin:– UW Health Organ Procurement Organization (“OPO”)– Wisconsin Donor Network (Milwaukee) – Lifesource ( Minnesota)

Regulated by the Centers for Medicare & Medicaid Services (CMS) and United Network for Organ Sharing (UNOS)

Accredited by the Association of Organ Procurement Organizations (AOPO)

Audited by the Food and Drug Administration (FDA), Tissue Banks (4) and Lions Eye Bank; Participate in The Joint Commission surveys

Role of an OPO

Coordinate the organ donation process– Donor management, organ allocation, transportation, surgical

recovery team(s), etc.– 86% of organs recovered transplanted at UWHC

Hospital development– Generate referrals from donor hospitals, educate and train

healthcare professionals, monthly death chart reviews, etc. Public education on organ donation awareness Donor family follow-up and donor family/recipient

correspondence Data reporting & regulatory compliance Coordinates services with tissue and eye banks

Governing Body

UWHC Authority Board is the governing body of the UWHC OPO with full legal authority & responsibility for management and provision of all OPO services:– Appoints individual responsible for day-to-day

operations– Delegates authority to review performance,

fiscal operations, oversee policies & procedures, and the Quality Assessment and Performance Plan

UW Health OPODonation Service Area

UWHC OPO105 hospitals70 counties

3.2 million population

Program Highlights

Twelve Donor hospitals received the 2009 U.S. Dept. of Health & Human Services (HHS) Medal of Honor– HHS Medal of Honor warded for a combination of

achieving the national goals for conversion rate, yield and DCD donors.

OPO received 2 awards this year for conversion rate and Donation after Cardiac Death (DCD) donors

Centers for Medicare/Medicaid (CMS) OPO Conditions of Participation

Updated CMS regulations effective 7/30/06 include standards for:– Certification and Designation– Re-certification and De-certification– Outcome Requirements– Process Performance Measures

• 486.324 Condition: Administration and Governing Body

– Requires Advisory Board and Governing Body

UWHC OPO must meet CMS Conditions of Participation to remain operational

Statistics

Over 103,000 people waiting for a transplant in the U.S. – Over 1,400 patients in Wisconsin

One person added to the list every 17 min or 3,000 patients each month

18 people nationwide die every day waiting One donor can potentially donate up to 8

solid organs and help up to 40-50 people

CMS Outcome Measurements

Donation or Conversion Rate (eligible donors/eligible deaths) – Cannot be 1.5 standard deviation below national mean (Next slide)

Observed Rate– Cannot be significantly lower than the Expected Rate (not yet

available) Two out of the 3 below cannot be lower than one

(1) standard deviation from national mean:

(i) Number of organs transplanted per standard criteria donor

(ii) Number of organs transplanted per expanded criteria donor

(iii) Number of organs used for research per donor

UW OPO* U.S. 3.66 3.64

2.45 1.81

.23?

*CY2008

Conversion Rates

78 75 78 81 84

8278

83 86 88

0

10

20

30

40

50

60

70

80

90

100

2004 2005 2006 2007 2008

Conversion Rate (%)

Adjusted Conversion Rate (%)

Conversion Rate:(Eligible Donors/Eligible Deaths)

Adjusted Conversion Rate: (Eligible Donors + Other Donors/Eligible Deaths + Other Donors)

National Average62%

Deceased Donor Activity

5357

80 7872 70

65

77

54

100

8285

81 8287

108

9996

100

115

131

117

127

137133

0

20

40

60

80

100

120

140

160

'84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08

Year

Nu

mb

er o

f D

on

ors

Donation After Cardiac Death (DCD)

Donation After Brain Death (DBD)

Total Donors

Record

UW Health OPODonor Referrals

236305

458

662

9041025

1497

1774

0

200

400

600

800

1000

1200

1400

1600

1800

2001 2002 2003 2004 2005 2006 2007 2008

Import & Export Organs

Exports, 52

Exports, 63

Exports, 64

Imports, 130

Imports, 119

Imports, 81

Imports, 80

Exports, 59

0 50 100 150 200

2005

2006

2007

2008

Difference = 16

Difference = 18

Difference = 60

Difference = 78

2010 Upcoming Events

First unannounced CMS survey Establishment of Wisconsin

statewide donor registry Co-host of U.S. Transplant Games

to be held in Madison on July 30-August 4, 2010