Purpose : To set meaningful Organ Procurement Organization (OPO) donation authorization performance metrics that remove unintended consequences of avoiding or delaying approaches.
Background: Organ Procurement Organizations (OPOs) are responsible for obtaining authorization, or to fulfill the documented wishes of a deceased donor. Potential donors succumb to circumstances leading to their demise or are in situations in which their decision-makers may elect to cease life-sustaining therapy. OPOs bear the responsibility of ensuring that we follow the decedent’s wishes and/or that decision-makers have information on which to base a donation decision at a challenging time.
Methods : Measuring whether the OPO obtained authorization seems like a logical measure of success, but nuance is a part of most potential donation scenarios. One OPO believed that identifying metrics reflective of the entire donation approach continuum would capture success and reveal opportunities for improvement. The OPO further believed that approaching as many families as possible instead of narrowing approaches based on presumptive criteria would improve donation rates. In other words, more approaches would statistically produce more donors, even if the authorization rate remained constant. Modification of performance measures included adding approach outcome, timely conversations, and reapproach in instances where non-OPO personnel prematurely introduced donation and met resistance. We introduced and explained the three performance measures to approach staff to increase confidence and mitigate resistance to approach on cases perceived likely to result in a decline. We encouraged reapproach strategies during performance reviews. We gave the team autonomy to assess and manage referral needs, introduce timely donation discussion, and reapproach as needed to increase referral efficiency allowing for an increase in the number of donation conversations.
Results: We collected data were over four quarters (Q): two quarters before implementation and two after. Q1 and Q2 showed 583 conversations while Q3 and Q4 had 789 conversations, an increase of 35%. The authorization rate for Q1 and Q2 was 55.2% while Q3 and Q4 was 52.9%, a slight decrease of 2.3%. The total donors for Q1 and Q2 were 215 organ donors as compared to 248 for Q3 and Q4, resulting in a 15% increase. Although the authorization rate had a slight decline, the increase in the conversation rate saw a 7% increase in donation rate.
Conclusions: Targeting performance measures related to multiple aspects of donation conversations resulted in more approaches, reapproaches, and timely conversations, and produced more organ donors and more organs for transplantation.