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Putting the Pieces Together: The National Donation and Transplantation Community of Practice

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

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Putting the Pieces Together: The National Donation and Transplantation Community of Practice

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  1. Putting the Pieces Together: The National Donation and Transplantation Community of Practice

  2. 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

  3. 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

  4. OPO and Donor Hospital Three Estates Potential Deceased Donor Population Donor Management Donation Donor Push Potential Recipient Populations Our National System Offer & Acceptance Organs Patient Transplant Centers Pull Wait List Management Organs Transplanted Center Capacity

  5. 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

  6. Deceased Donor Organs Transplanted

  7. Deceased Donor Organs Transplanted

  8. Deceased Donor Organs Transplanted

  9. Deceased Donor Organs Transplanted

  10. Steady Increases in Monthly Organs Transplanted September 2003: 1800 organs May 2009: 2100 organs Target: 2900 organs

  11. Increasing Capacity by 20%

  12. Waiting List Deaths1999-2008

  13. Waiting List Deaths1999-2008

  14. Waiting List Deaths1999-2008

  15. Waiting List Deaths1999-2008 1999 - 2003 2004 -2008 Total Deaths 34,380 34,236 Deaths/Year 6,876 7,047 Deaths/Day 19 19

  16. System Measures:Five Defining Rates

  17. Conversion Rate

  18. Conversion Rate Goal • National Goal: • 75% Collaborative Conversion Rate • (All Donors) / (Eligible) * 100

  19. Types of Donors • 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)

  20. Organ Donor Increases1999-2003 v 2004-2008

  21. Organ Donor Increases1999-2003 v 2004-2008

  22. Organ Donor Increases1999-2003 v 2004-2008

  23. Monthly Conversion Rate Nearing 75% Goal 22 of 58 DSAs at 75% for a continuous 12-month period

  24. Organs Transplanted Per DonorOTPD

  25. Organs Transplanted per Donor

  26. Organs Transplanted per Donor

  27. Organs Transplanted per Donor

  28. DSAs Mobilizing for OTPD Breakthrough Only one DSA has achieved 3.75 for 12 continuous months SCD OTPD 2008: 3.80 SCD OTPD 2009: 4.56

  29. DSAs at 3.75 or higher for Standard Criteria Donors

  30. Donation After Cardiac DeathDCD

  31. Organ Donor Increases1999-2003 v 2004-2008

  32. Sustained Increases in DCD 28 of 58 DSAs meet the 10% Goal 9 additional DSAs at 7-9%

  33. Sustained Increases in DCD >4700 organs tx In 2004-2008 28 of 58 DSAs meet the 10% Goal 9 additional DSAs at 7-9%

  34. 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

  35. Larger Hospitals Meet Goals Less Frequently

  36. Pediatric Transplantation

  37. 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

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