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Implementation notice: Two new transplant performance metrics now in effect

Implementation notice: Two new transplant performance metrics now in effect

Implementation date

July 14, 2022

At-a-glance

Effective July 14, the OPTN Membership and Professional Standards Committee (MPSC) will consider program performance on two post-transplant metrics:

  • 90-day graft survival hazard ratio: A program’s rate of graft failure from date of transplant to 90 days post-transplant, relative to the expected rate based on transplants with similar recipient and donor organ characteristics across the nation.
  • 1-year conditional on 90-day graft survival hazard ratio: A program’s rate of graft failure from day 90 post-transplant to day 365 post-transplant, conditional on the graft surviving for the first 90-days post-transplant, relative to the expected rate based on transplants with similar recipient and donor organ characteristics across the nation.

No later than July 30, 2022, the MPSC will send inquiries to programs based on an evaluation of transplants that occurred from January 2019 through June 2021 (excluding the March 13 – June 12, 2020, SRTR COVID carve-out), using the new metrics.

Approved bylaw revisions that clarify the performance review process, codify the current peer review process, and add and revise definitions are also effective as of July 14, 2022. Read the phase I policy notice.

Member monitoring resources

The compliance and evaluation page on the OPTN website has guidance about compliance and performance monitoring. These documents provide information to assist members undergoing OPTN monitoring and to help prepare for any interactions with the MPSC:

New resources on your SRTR secure site

The SRTR secure site now includes information to help you understand whether your program meets the new MPSC performance monitoring criteria for all four metrics. This information is intended to support you as you plan and evaluate your program’s performance.

The SRTR secure site also includes information that notes whether a program is in the performance improvement (yellow) zone for member use. OPTN staff will provide programs that fall within this zone information on available performance improvement resources, but programs that fall within this zone will not be obligated to interact with the MPSC.

While the SRTR is providing information on all four metrics, only the two post-transplant graft survival metrics detailed in this email are effective as of July 14, 2022.

Toolkit and professional education 

A policy toolkit on the OPTN website has extensive information about the new performance monitoring system. The toolkit is an information hub for the community, and is where members can learn more about the implementation of the new bylaws, including these resources:

Additionally, online educational resources about performance monitoring are available to help members understand the changes.

  • QLT150: MPSC Transplant Program Performance Monitoring
    • Provides an overview of the performance monitoring system
  • QLT151: MPSC Post-transplant Outcomes and Risk Adjustment*
    • Concerns the two new post-transplant metrics that are in effect as of July 14, 2022
  • QLT152: MPSC Offer Acceptance Rate Ratio and Risk Adjustment*
    • Focuses on the pre-transplant offer acceptance rate ratio that will implement no sooner than July 2023
  • QLT153: MPSC Pre-transplant Mortality Rate Ratio and Risk Adjustment
    • Focuses on the pre-transplant mortality rate ratio that will implement no sooner than July 2024

The resource document on effective practices for improving post-transplant outcomes is also available on UNOS Connect.

  • QLT107-D: Effective Practices for Improving Post-transplant Outcomes

Visit UNOS Connect to access these resources and learn more about the changes:

*Confers CEPTC credits

Future implementation of pre-transplant metrics

Evaluation of programs based on the two pre-transplant metrics criteria will be phased over the next two years:

  • Offer acceptance rate: no earlier than July 2023
  • Pre-transplant mortality rate: no earlier than July 2024

Background

The OPTN Board of Directors approved revised bylaws for transplant program performance monitoring on Dec. 6, 2021. The approved bylaws include four new metrics for evaluation of transplant program performance:

  • Pre-transplant mortality rate
  • Offer acceptance rate
  • 90-day post-transplant graft survival rate
  • One-year post-transplant graft survival conditional on 90-day graft survival rate

Read the full policy notice.

Questions?

We understand you may have questions about these changes, and are glad to provide any information you need about the implementation of the new performance metrics.

Please contact us at MPSCReports@unos.org

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