*Purpose: Organ Procurement Organization (OPO) performance assessment is essential for identifying best practices and improvement opportunities. We aimed to evaluate OPO performance using the following metrics: 1) donors per death, 2) donors per eligible death, 3) eligible donors per eligible death, and 4) eligible donors per donor.

*Methods: We calculated these metrics using the CDC National Death Index and OPTN data for adult donors in 57 OPOs from 2008-2016. We assessed variation in donation rates between OPOs and over time. Using beta regression, we analyzed the association of age, sex, race, year of donation, cause of death (COD), BMI, and OPO with donation. We assessed the relationships between donation rates using Spearman’s correlation.

*Results: Selected regression results are in Table 1. Likelihood ratio tests showed that all included patient factors were significantly associated with each of the donation rates (α=0.05). However, the number of total deaths within an OPO was not associated with the donation metrics. Figure 1 shows eligible donors per donor rate variation from 2008-2016 by OPO. The ranking of OPO performance varies considerably depending on the metric used. Nationally, 21% of donors did not meet the definition of eligible death, and the use of these donors varied significantly between OPOs and varied by donor demographics. Accounting for other demographic factors and COD, white donors who did not meet eligibility criteria were significantly more likely to be accepted for donation than non-white donors (p<0.01).

*Conclusions: OPO variation and the substantial proportion of donors used from outside the eligible death definition suggest OPO performance should be evaluated based upon expanded metrics.

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