Organ procurement organization (OPO) performance metrics have been scrutinized due to the perceived disincentives of the regulatory system. In kidney transplantation, OPOs are evaluated on kidney yield and may perceive that recovery of high-risk kidneys increases the risk of regulatory review. OPOs and transplant programs may also perceive that their performance metrics work in opposition to each other. The risk adjustment of OPO kidney yield removes the possibility of regulatory review due to recovery of high-risk kidneys, and reduces the possibility that OPO and transplant program performance metrics are correlated. We evaluated the association of OPO kidney yield with both donor kidney donor risk index (KDRI) and donation service area (DSA) hazard ratios for 1-year deceased donor posttransplant graft survival, which aggregate the deceased donor transplants performed in a DSA. We also evaluated the association of kidney utilization within a DSA with (1) OPO kidney yield, (2) percentage of hard-to-place kidneys (i.e., required more than 100 offers), and (3) percentage of locally placed kidneys. Kidney utilization was assessed by offer acceptance ratios estimated from match runs that ended in acceptance in 2015 and were adjusted for donor and candidate factors. Adjusted OPO kidney yield was not associated with donor KDRI or 1-year posttransplant graft survival (Figure 1). However, below average offer acceptance behavior was weakly associated with lower kidney yield but strongly associated with a higher proportion of hard-to-place kidneys and a lower proportion of locally placed kidneys (Figure 2). OPO and transplant program performance metrics were not associated, but below average kidney utilization within a DSA increased the difficulty of kidney placement.

Figure 1Figure 2

CITATION INFORMATION: Wey A, Salkowski N, Kasiske B, Israni A, Snyder J. OPO Performance Metrics: Relationship with Kidney Transplant Program Performance Metrics and Kidney Utilization. Am J Transplant. 2017;17 (suppl 3).

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