Working collaboratively to enhance system performance and improve transplant program monitoring metrics

Matthew Cooper, M.D., begins his term as the new president of the Board of Directors of the Organ Procurement and Transplantation Network (OPTN) at a time when the broader transplant community is looking to improve how transplant programs are monitored for performance. A proposal to improve the current metrics, sponsored by the OPTN Membership and Performance Standards Committee (MPSC), will be open for community input beginning Aug. 3.

“I think we have to recognize that change is not always easy. From a transplant perspective, the community will really want some time to think about what’s being proposed and consider what the implications will be,” says Cooper, director of kidney and pancreas transplantation at MedStar Georgetown Transplant Institute at MedStar Georgetown University Hospital. “Those implications also include the donation and transplant community’s ongoing ability for self-regulation should we choose not to respond to what is certainly an expectation for changes in transplant hospital metrics that would complement those recently imposed on organ procurement organizations [OPOs].”

“A major change involved with the proposed new metrics is that transplant programs would be evaluated above and beyond their desire and ability to solely list candidates and ensure their transplanted patients do well in the short term,” explains Cooper.

The MPSC currently uses a single post-transplant metric—one-year patient and graft survival—to monitor transplant program performance, and many in the community feel the current framework can be a disincentive to transplantation. “We need to appreciate the promise involved in working to get patients transplanted—and not just listed,” Cooper says.

His hope?

“That this will transpire into better decision-making, fewer opportunities for slowing down the allocation process, and increased desire to work more collaboratively, which is really what this is all about.”

Community feedback is critical to the development of the new transplant program performance metrics, and stakeholders will need to educate themselves before they participate in public comment. The OPTN will host a webinar Aug. 4 and another in September to review the proposed changes. Members and the public are encouraged to attend the webinars (or view the recordings) before commenting on the OPTN website and participating in the regional meetings that will take place across the country through the end of September. A recording of a previous June 2 webinar outlining the changes and rationale is available for viewing now.

A focus on system performance

Improving system performance—a key part of the OPTN strategic plan—has been a through-line for Cooper over the course of his career in transplant. A surgeon with a patient-centric approach, Cooper has previously held positions on the MPSC as well as the OPTN Policy Oversight and Living Donor Committees, the latter of which he also chaired. He has played a key role in numerous OPTN improvement initiatives, including a kidney paired donation workgroup, a living donor data task force, and the COIIN advisory council. In addition to his OPTN service, Cooper currently holds board positions at both the National Kidney Foundation and Donate Life America, serves as president of the American Foundation for Donation and Transplantation and is a Councilor with the American Society of Transplant Surgeons.

But Cooper’s work co-leading the OPTN Ad Hoc Systems Performance Committee (SPC) is perhaps the most closely connected to the MPSC’s proposed changes to transplant program performance monitoring. The committee included representation from transplant programs, OPOs, patients and donor families. Together, they considered metrics and elements that could be universally accepted as performance standards—for OPOs, transplant programs, and the system as a whole—and worked to identify ways the OPTN can support system performance.

The SPC and the need for holistic change

“When I was asked to lead the committee, my goal from the start—and what I promised our volunteer participants— was to end up with something substantive that would be a true effort to make change,” says Cooper.

In the SPC’s 2019 report to the board, the committee included performance monitoring enhancement as one of the four areas for which it provided recommendations. Now, the MPSC has been charged with continuing the work of the SPC in this area.

“If you look at the recommendations that came out of the SPC workgroups, you can recognize so many different things that have since come to fruition, or have been put into the programming and planning stages. The new transplant program performance monitoring metrics in some ways was the starting point for this. We’ve been talking about changing metrics for well over a decade—so it’s a very critical piece.”

“With the MPSC project going out for public comment in 2021, we’re truly focused on the system,” says Cooper. “We want to make everything focused on how the system can work better, whether it’s enhanced transplant performance monitoring, or OPOs working with donor families, or transplant programs working with OPOs, or how referring physicians and dialysis centers work with transplant programs. Everybody working collaboratively means that we will all do better for patients.”

The MPSC: Performance partner

Cooper wants the transplant community to understand that the MPSC is made up of people who work in the transplant space, just like them, and their desire is to improve everyone’s performance for the benefit of patients. “The MPSC is made up of people who are really interested in process improvement and in protecting the sanctity of transplant.”

“The committee is not ‘them’ or ‘they’—it’s you, and me. It’s all of us across the system,” he explains. Improving performance metrics is part of the MPSC’s charge to ensure both the public trust and the safety of organ donation and transplant by fulfilling their obligation as set up in the OPTN contract.

To that end, Cooper also recognizes that the results may not be what every transplant hospital would like. “But we always have to think that we’re working in the service of patients,” he explains. “As a community, we can’t selfishly focus on what could be the best thing for my transplant program, or OPO. It’s got to be what’s best for patients. That has to be our guiding principle.”

The MPSC released their proposal to enhance the transplant program performance monitoring system for public comment on Aug.3, 2021. All proposals this cycle are open for public comment through Sept. 30, 2021, on the OPTN public comment page. During the two-month public comment period, the community is invited to provide feedback and input about the proposed changes to transplant program performance monitoring.

Do you have questions about the MPSC performance monitoring project?

Please contact Sharon Shepherd at [email protected].