The Board of Directors of the Organ Procurement and Transplantation Network approved revised bylaws for transplant program performance monitoring on Dec. 6, 2021. The OPTN Membership and Professional Standards Committee proposed these changes in order to establish a comprehensive system that can more holistically evaluate transplant program performance. The bylaw revisions include changes to the MPSC’s transplant program performance review process including new measures of performance, the addition of language codifying the current peer visit process and the addition and revision of relevant definitions.
A more comprehensive system
The four metrics approved by the board include both pre-and post-transplant patient outcomes. This is a change from the current system, where the only factor considered by the MPSC in the evaluation of program performance is 1-year patient and graft survival. The new metrics are expected to reduce the emphasis on post-transplant outcomes and increase the number of transplants.
The approved bylaws include four new metrics for performance evaluation:
- Pre-transplant mortality rate
- Offer acceptance rate
- 90-day post-transplant graft survival rate
- 1-year post-transplant graft survival conditional on 90-day graft survival rate
The OPTN will implement the new metrics in phases over the next three years. Education is in development. Read the policy notice that describes all the changes.
Transplant program performance review changes to implement in July 2022
Approved bylaw revisions that clarify the performance review process, codify the current peer visit process, and add and revise definitions will become effective July 14, 2022.
In addition, the two new post-transplant performance monitoring metrics will become effective July 14, 2022.
At implementation, the MPSC will consider program performance on these two metrics for transplants that occurred from January 2019 through June 2021 (excluding the March 13, 2020 – June 12, 2020 SRTR COVID carve out).
Inquiries will be sent to transplant programs based on MPSC evaluation of SRTR analysis, developed specifically for the MPSC, of:
- 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 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 based on transplants with similar recipient and donor organ characteristics across the nation
These two new metrics will replace the current 1-year post-transplant graft and patient survival criteria used by the MPSC to identify programs for performance review.
The OPTN will provide additional information on implementation, education and resources over the next few months.
Evaluation of programs based on the two new pre-transplant metrics criteria will be phased and will begin on the following timeline:
- Offer acceptance rate: No earlier than July 2023
- Pre-transplant mortality rate: No earlier than July 2024
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 utilization.
Watch a presentation about how risk-adjustment works.
We are glad to provide any information you need as the community prepares for the implementation of the new performance metrics. Please contact OPTN contractor staff at [email protected].