Session Time: 3:15pm-4:45pm
Presentation Time: 3:39pm-3:51pm
*Purpose: In August 2019, the OPTN Kidney (KI) Transplantation Committee put forth a proposal for public comment to replace DSA and region from KI allocation with 500NM circle (with proximity points). Through community feedback there was concern the proposal would systematically shift KI from “high” to “low” performing OPOs.
*Methods: We examined Spearman correlation coefficients between the projected net difference in solitary KI transplant (TX) volume by DSA from KPSAM output regarding a 250NM and 500NM allocation circle with the following OPO metrics: observed to expected (O:E) KI yield; standardized donation rate among ‘eligible deaths’; KI donor conversion ratio among ‘eligible deaths’; TX per 100 potential donors from the Washington Post; donor conversion rate utilizing OPTN Deceased Donor Potential Study (DDPS) methodology. To assess robustness of findings in light of a potential outlier (highly influential data point), analyses were replicated without a single DSA (NYRT) predicted to see 500+ additional solitary KI TX under broader distribution.
*Results: Among case-mix risk adjusted OPO metrics, Spearman correlations ranged from -0.09 to -0.04 with no statistical significance (all p≥0.25). For example, net change in KI TX and O:E KI yield showed no relationship (p>0.88) for both 250 and 500NM; this lack of relationship held with and without NYRT.
KI donor conversion ratio was the only statistically significant finding (p=0.005), but is not case-mix adjusted and based on the widely criticized ‘eligible death’ metric; it was no longer significant (p=0.11) after removal of NYRT.
*Conclusions: Nationwide, we found little to no evidence suggesting the proposal would systematically shift KI from “high” to “low” performing OPOs. Examples can be seen of certain low-performing OPOs (and thus likely certain programs) realizing a predicted increase in TX under allocation systems with broader sharing, but no systematic national trend was seen. Despite the absence of a “gold standard” for measuring OPO performance, our analysis is strengthened by the use of multiple current approaches to benchmarking OPOs.
To cite this abstract in AMA style:Wilk A, Gustafson S, Stewart D, Salkowski N, Zaun D, Snyder J. Broader Distribution of Kidneys Not Projected to Systematically Favor “Low” Performing OPOs [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/broader-distribution-of-kidneys-not-projected-to-systematically-favor-low-performing-opos/. Accessed March 6, 2021.
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