Purpose: Organ Procurement Organizations collaborate with partner hospitals to implement triggers that prompt the hospital to refer a potential donor. New OPO performance metrics require understanding both the potential for donation and the OPOs’ success in responding to those referrals by measuring the number of organ donors from the potential pool of donors (CMS 42 CFR §§486.301-348). One OPO sought a deeper understanding of their referral and to identify areas for improvement.

Background: Complex conditions clouded triage at times. For example, a patient placed into Therapeutic Hypothermia could have a quite different clinical picture after treatment, but remained in limbo for the OPO until a prognosis was determined. The OPO receives many “early” referrals; that is, the referred patient may have suffered a debilitating event, but they have not lost reflexes; their physician may have ordered hypothermic protocols; or there is no indication that the patient’s condition is grave. The OPO follows fifty referrals a day on average and sought to standardize referral responses to the highest level of consistency possible.

Methods: Hospitals made 7,862 organ referrals in 2022. Because the clinical triggers are broad, the OPO found itself with a high number of referrals and limited ability to respond to them consistently, leading to disjointed responses often limited by staff availability, travel distance, and even the weather. Analysis gave insight into staffing design that provides staff with the ability to respond at key times in the referral process. It was clear that additional staff were necessary.

Results: To better understand this high volume of referrals and how the OPO responds, a multi-disciplinary committee was formed to review, weekly, all referrals with organ potential and to ensure any opportunity for improvement by either the OPO or the donor hospital was identified.
As a result, the OPO designated response and readiness triggers to define when to remain on site after initial review. These include situations where this OPO believed that someone should be onsite as the highest priority.  The assertion is that if a response was made at these triggers, there would be an earlier and more successful opportunity to speak to families to offer the option to donate and to increase donors. 

Conclusions: Early data point to success. So far in 2023 the OPO showed a 21% increase in the number of approaches made per quarter from 2022 and a commensurate increase in donors.