PREFACE
The Health Resources and Services Administration (HRSA), Healthcare Systems Bureau (HSB), Division of Transplantation (DoT) contracts with the United Network for Organ Sharing (UNOS) to administer the Organ Procurement and Transplantation Network (OPTN). It also contracts with the University Renal Research and Education Association (URREA), with collaboration from the University of Michigan, to administer the Scientific Registry of Transplant Recipients (SRTR). Both contracts require an Annual Data Report, though each contractor has separate responsibilities within the report. URREA coordinated the descriptive chapters and prepared the data-related sections of this report, including the Data Tables, Glossary, and Technical Notes. UNOS arranged for the report's production and dissemination.
This Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients represents the 14th such annual report and is based largely on data pertaining to the 10-year period from 1994 to 2003.
This preface describes the changes from previous reports and also serves as an introduction to the sections that follow.
The Annual Report this year is again published in an electronic version, eliminating the paper copy. Continuing in the format established in 2002, more than 40 experts from the transplant community contributed to this year's report. Along with an Executive Summary, these expert descriptions of data highlights and trends, coordinated by SRTR staff, are presented in Chapters I through X. These chapters function as more than simple summaries; they are multi-authored and peer-reviewed analyses, complete with references, separate figures, and additional explanatory tables. Some of the chapters address topics traditional to the Annual Report, including trends in organ-specific and pediatric transplantation, organ donation, and database issues. Additionally, many of the chapters include a section on current organ allocation policy. One of the chapters, "Quantifying Organ Donation Rates by Donation Service Area," addresses topics that have not been discussed in detail in previous annual reports. The "Analytical Approaches" chapter examines many of the issues involved in selecting the analytical methods used for this report, the Center- and OPO-Specific Reports, and other SRTR analyses. We are pleased to note that slightly modified versions of these chapters also will be published as stand-alone, peer-reviewed articles in "The 2004 SRTR Report on the State of Transplantation," as a special issue of The American Journal of Transplantation.
Data Tables
Fifteen topic-specific sections of descriptive data include the summary tables referenced in the preceding chapters, as well as detailed data on the following topics over the last 10 years of transplantation:
Below are notable changes to this year's tables.
A comparison of changes over time in post-transplant graft and patient survival is presented in a new table included within each set of organ-specific tables. These tables show survival rates at different follow-up periods (3 months; 1, 3, and 5 years), separately for transplants performed in each of the last ten years. (Tables 5.10, 5.13, 6.10, 6.13, 7.10, 7.13, 8.10, 8.13, 9.10, 9.13, 10.10, 10.13, 11.10, 11.13, 12.10, 12.13, 13.10, 13.13)
For heart and liver, one new table describes events and status changes while on the waiting list. These new measures of waiting list outcomes for urgent registrants in status-based allocation systems replace the time to transplant table (Tables 9.2, 11.2). Time to transplant tables are still produced for other organs, and for heart and liver in the Supplementary Tables section.
New deceased donor organ utilization tables (Tables 2.12 through 2.17) account for all other organs recovered from each donor.
Separate kidney tables for recipients of expanded criteria donor (ECD) and non-ECD kidneys were introduced last year for the transplant recipient characteristics descriptions (Table 5.4). This year, this distinction has been expanded, and separate tables are also produced by ECD and non-ECD deceased donors, and for living donors, for immunosuppression use (Table 5.6) and post-transplant death rate and survival tables (Tables 5.7 through 5.13).
Posttransplant death rate tables for liver and lung now report transplants from deceased and living donors separately (Table 9.7, 12.7)
A "Supplementary Tables" section has been added to include tables that have been discontinued from the main sections. These data tables are produced for comparison to earlier Annual Reports. In their original sections, they have been replaced by a new table of updated format or interpretation.
Appendices
The Technical Notes describe the data presented in the tables, including the calculations and analytical methods used. The notes follow the topical order of the tables and, along with the Glossary, have been moved into the Resources section as references.
For Additional Information
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Suggested Citation (Full): 2004 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1994-2003. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, Rockville, MD; United Network for Organ Sharing, Richmond, VA; University Renal Research and Education Association, Ann Arbor, MI.
Suggested Citation (Abbreviated): 2004 OPTN/SRTR Annual Report 1994-2003. HHS/HRSA/HSB/DOT; UNOS; URREA.
Publications based upon data in this report or supplied upon request must include the above citation as well as the following statement:
The data and analyses reported in the 2004 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by UNOS and URREA under contract with HHS. The authors alone are responsible for reporting and interpreting these data.
Most of the data in this report are provided on a voluntary basis by transplant programs, histocompatibility laboratories, and organ procurement organizations throughout the United States. HRSA, UNOS, and URREA gratefully acknowledge the work of transplant professionals whose efforts have made it possible to compile and analyze transplantation data collected across the nation. We especially wish to thank transplant data coordinators for their efforts in providing the data used in this report.
This report has been compiled through the collective efforts of many individuals. We wish to acknowledge contributions by URREA and University of Michigan staff members Charlotte J. Arrington; Valarie B. Ashby, MA; Rami Bustami, PhD; John Q. Chen, MS; Laura L. Christensen, MS; Charlene R. Cole; Kerry Colligan; David M. Dickinson, MA; Dawn M. Dykstra; Nathan P. Goodrich, MS; Mary K. Guidinger, MS; Tempie E. Hulbert-Shearon, MS; Chris Kim; Greg N. Levine; Alan B. Leichtman, MD;B John C. Magee, MD; Keith P. McCullough, MS; Joshua J. McGowan, MS; Jennifer L. McCready; Robert M. Merion, MD; Susan Murray, ScD; Sarah K. Naperala; Akinlolu O. Ojo, MD, PhD; Trinh B. Pifer, MPH; Friedrich K. Port, MD, MS; Ann M. Rodgers; Douglas E. Schaubel, PhD; Caroline A. Shevrin, MS; Randall S. Sung, MD; Randall L. Webb; James C. Welch; and Robert A. Wolfe, PhD.
We also wish to acknowledge contributions by UNOS staff members Alan Ting, PhD; Cameron Albert; Jane Koonce; Michael Sloss; Robert Todd; Tim Yagla; Robbie Wagner; Sherri Williams; and Donna Whelan.
In addition to the aforementioned individuals, we gratefully acknowledge the individuals listed in Chapters I through X for their invaluable contributions to the design and implementation of these chapters.
Finally, HRSA, UNOS, and URREA gratefully acknowledge donor families and transplant recipients, whose generosity and courage have made advances in organ transplantation possible.
Amy M. Pugh, MA, OPTN Project Coordinator
Sarah N. Miller, MSW, SRTR Co-Editor
Miles P. Finley, SRTR Co-Editor
Shiqian Li, SRTR Co-Editor