The OPTN implemented Share-35 in June 2013 to increase regional sharing. Organ Procurement Organization (OPO)-level changes in utilization subsequent to Share-35 have not previously been described.

Methods: Using SRTR data, we compared the 12 months before Share-35 to the 12 months after Share-35 using multilevel empirical Bayes (EB) estimation and competing risk regression. Share-35 associated changes are reported for (1) region-stratified waitlist mortality, (2) OPO-level transplant rates, (3) OPO-level discard rates adjusted for DRI, and (4) OPO-level cold ischemia time (CIT). Log likelihood ratio tests were used to determine whether variation between OPOs (random slope) was significant.

Results: Waitlist mortality declined in 8 of 11 regions; however the decline was only statistically significant in Region 5 (p<0.01).

The change in EB-estimated transplant rate by OPO ranged from a 0.82 to 1.2-fold difference. Among OPOs in the highest tertile of pre-Share35 transplant rate, the transplant rate declined by 14% (95% CI: 1%-25%) under Share-35 (p=0.04). Among the remaining OPOs, the transplant rate increased by 9% (5%-14%) (p<0.001, Figure 1).

Among the tertile of OPOs with the highest pre-Share35 discard rate, the discard rate declined by 25% (11%-36%) under Share-35 (p<0.001). There was no evidence of change in discard rate for the remaining OPOs (p>0.5).

The change in EB-estimated mean CIT by OPO associated with Share-35 ranged from a 19-min decrease to a 30-min increase. Although overall change in CIT was not statistically significant (p>0.5), it varied between OPOs (p=0.02).

Conclusions: Transplant rates in OPOs with the highest pre-Share35 transplant rates declined, while transplant rates in OPOs with lower pre-Share35 transplant rates increased. Discard rates in OPOs with the highest pre-Share35 discard rates declined. Changes in CIT differed between OPOs.

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