Introduction: The highest priority in the Organ Procurement and Transplantation Network (OPTN) Strategic Plan is to increase the number of transplants among patients with end-stage organ disease in the United States. While recent policy changes have focused on allocating organs to those most in need and lessening geographic disparity in accessing organs, the only mechanism to increase the total numbers of transplants is to maximize the potential organ supply. The potential gains that could be achieved by increasing donor authorization rates of potential organ donors are unknown.

Methods: We conduced a retrospective cohort study using UNOS data from 1/1/08-11/1/13 on eligible deaths. Multivariable logistic regression models were fit to estimate adjusted organ procurement organization (OPO)-level donor authorization rates, accounting for demographic and geographic variables, and to estimate the increased donor yield associated with increased authorization rates.

Results: Despite adjustments for donor demographics (age, race/ethnicity, gender, and cause of death) and geographic factors (rural/urban status of donor hospital, number of transplant centers within an OPO, and statewide participation in deceased-donor registries) among 52,571 eligible deaths, there was significant variability (p<0.001) in authorization rates for donation across the 58 OPOs. The overall OPO-level adjusted authorization rates ranged from 63.5-89.5%, with a median of 72.7%. During the study period, an additional 773-1,623 eligible deaths could have been authorized for donation, yielding 2,679-5,710 total organs, if the OPOs performing below the median and 75th percentile, respectively, implemented interventions to perform at the level of the corresponding reference OPO.

Conclusions: These results indicate that opportunities exist within the current organ acquisition framework to significantly improve OPO-level donor authorization rates. To achieve this, efforts to assist underperforming OPOs and regions should be the initial focus. Such initiatives would increase the number of transplants, mitigate waitlist mortality, and enhance redistricting initiatives.

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