Introduction: The influence of an observer on the phenomena being observed is designated as the observer effect. It is our aim to demonstrate that an observer effect exists in liver transplantation.

Methods/Results: The Organ Donation Breakthrough Collaborative in 2003 focused attention on OPO performance by assessing the rate of conversion of eligible donors to actual donors, rather than population-based donor production. Shortly after policy implementation, the national conversion rate of eligible donors per million population surged from 52% in 2003 to 74% in 2014 (p<0.001). Despite the success associated with the metric of donor conversion, the overall donor production was virtually stagnant over the same period in the setting of a nearly constant national death rate (Figure 1). The surging conversion rate was due to OPOs declaring fewer eligible donors per million population.

Another example of the observer effect relates to the myopic focus on 1-year survival rates after transplantation. 1-year survival has improved dramatically, while other important outcomes have had no substantial improvement, including waitlist survival and long-term survival.

Conclusions: The above example of observer effects in solid organ transplantation indicate the importance of carefully choosing regulatory metrics. Regulation creates an observer effect, influencing clinical behavior to favor the chosen outcome metric.

CITATION INFORMATION: Rana A., Kueht M., Galvan N., Cotton R., O'Mahony C., Goss J. Examples of the Observer Effect in Transplantation- Unintended Consequences of Regulation and Selected Outcome Metrics Am J Transplant. 2017;17 (suppl 3).

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