Two new post-transplant performance metrics are now in place for the evaluation of transplant program performance. Two additional pre-transplant metrics will have a phased implementation in 2023 and 2024. These metrics are part of a more comprehensive monitoring system developed by the Membership and Professional Standards Committee (MPSC) in order to establish a system that can more holistically evaluate transplant program performance. The Board of Directors of the Organ Procurement and Transplantation Network (OPTN) approved these changes last December.
The post-transplant metrics now in effect are:
- 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. A policy toolkit has more information and resources for transplant professionals about the new system, including policy documents and education.
A more comprehensive system
The new system considers both pre-and post-transplant patient outcomes. This is a change from the previous system, where the only factor considered by the MPSC in the evaluation of program performance was 1-year patient and graft survival. The new metrics will provide a broader view of patient care throughout the transplant journey, and will reduce the emphasis on post-transplant outcomes. These changes are expected to increase the number of transplants. Visit the toolkit for more information about the metrics and their implementation timelines.
The importance of risk adjustment
The new metrics will be risk-adjusted, which helps the MPSC account for differences in patients and donors. Risk-adjusting metrics means that transplant programs are not penalized for transplanting more complex patients or accepting more complex organs in order to increase organ utilization, which is an OPTN strategic goal. Watch a presentation about how risk-adjustment works.
Policy development and public comment
Public comment for the proposal, Enhance Transplant Program Performance Monitoring System, was open Aug. 3 – Sept. 30, 2021. Read the proposal and review the public comments.
As part of the policy development process, the MPSC reviewed the community feedback and incorporated appropriate changes before sending the proposal to the board. Learn more about the policy development process.
Please contact OPTN contractor staff at MPSCReports@unos.org for more information about performance monitoring.