US Transplant -- Scientific Registry of Transplant Recipients

Report Published January 2007
Report Published January 2007		PDF		Technical Methods PDF HTML	Map

Pacific Northwest Transplant Bank, Portland, OR

	X

	X

A Guide to Reading and Understanding the Center-Specific Reports (CSRs) Prepared by the Scientific Registry of Transplant Recipients (SRTR)

Donation Service Area (DSA) served by Pacific Northwest Transplant Bank (ORUO)

Overview:

These Organ Procurement Organization (OPO) reports contain a wide-range of information about the 59 individual OPOs whose role is to facilitate the organ procurement process in the US. These data also reflect the donor hospitals and transplant centers with which the OPOs work in their respective Donation Service Areas (DSAs). Information presented includes measures of donation, such as the number of organs recovered and percent transplanted from deceased donors, as well as measures of supply and demand that often vary by DSA, such as the time to transplant among waitlist candidates. Many of the tables include comparison points, such as the national average or a risk-adjusted measure of what would be expected for a similar OPO. These reports are based on data submitted to the Organ Procurement and Transplantation Network (OPTN) by the OPO, as well as by hospitals and transplant centers working as part of the transplant process.

Table 1 summarizes the number of donors and organs recovered from the deceased donor population, and the percent of donors for whom organs were recovered and transplanted within this DSA. Pacific Northwest Transplant Bank (ORUO) recovered organs from 98 donors between 07/01/2005 and 06/30/2006, including 11 after Cardiac Death (DCD), 23 Expanded Criteria Donors (ECD), and 64 "standard criteria" donors. An average of 4.09 organs were recovered from each standard donor at this OPO, as compared to an average of 4.01 organs per standard donor nationally. Table 2 shows the transplant centers at which these recovered organs were transplanted.

Measures of donation as well as their basic components vary by hospital and DSA. Tables 3 provides a donation rate, or conversion rate, that measures the fraction of eligible potential donors who become actual donors by having at least one organ recovered for transplant. Table 3 also shows a notification rate, which measures the fraction that are identified as potential donors among "notifiable deaths." Notifiable deaths include in-hospital deaths in the DSA which might be considered suitable for donation.

Both the donation rate and the notification rate are displayed with unadjusted and adjusted comparison points. The national average, an unadjusted comparison point, suggests to the user that overall donation - or notification - rate is higher or lower than average. The expected rate, an adjusted comparison point, suggests to the user that the rate is higher or lower than what would be expected given the experience among OPOs with similar service areas across the country. The expected rate is measured to reflect the characteristics of the hospitals served (e.g., number of beds or trauma units); of the DSA (such as population density); or, for notification rates, the population mix and cause of deaths among the notifiable deaths.

The donation rate observed for the Pacific Northwest Transplant Bank (ORUO) OPO and its DSA between 07/01/2005 and 06/30/2006 is 74.6 donors per 100 eligible deaths. This rate was calculated by dividing the number of donors that meet the eligible death criteria by the number of eligible deaths in this DSA (85 divided by 114). In addition to the observed donation rate, organ-specific rates are provided for kidney, liver, heart, lung, pancreas and intestine. An observed notification rate is also reported, which provides a rate of eligible deaths identified per 100 notifiable deaths.

The expected (adjusted) rates in Table 3 provide a comparison to the observed measures described above. The expected donation rate of 56.9 donors per 100 eligible deaths indicates what rate would be expected, given the nationwide performance in organ procurement, if the entire country had the same hospital and DSA characteristics as this DSA. Any difference seen between the expected donation rate of 56.9 and the national average of 60.8 donors per 100 eligible deaths may indicate that the characteristics of this DSA are typically associated with higher (or lower) donation rates. These characteristics might include more or fewer hospitals in this DSA with a level 1 or 2 trauma center, hospitals with higher or lower CMS case mix indices, or hospitals with larger or smaller numbers of total beds or ICU beds.

The p-value of <0.01 indicates that this difference between the observed and expected rates of donation, 74.6 vs. 56.9 donors per 100 eligible deaths, is statistically significant, or unlikely to have occurred due to random chance.

Table 6 provides a way to look at how quickly patients receive transplants at centers within this DSA. Among the centers in the Pacific Northwest Transplant Bank (ORUO) DSA, 8.1 percent of patients placed on the kidney waiting list had received transplants as of 30 days after being placed on the waiting list. Those not transplanted, the other 91.9 percent, were either still waiting or removed from the waiting list for reasons including death. At one year after placement on the waiting list, 56.4 percent of patients at centers in this DSA had been transplanted, compared to 15.4 percent for centers in other DSAs in the nation. The table also shows similar figures for subgroups of patients, such as by age, disease, or medical urgency, allowing the reader to see if specific groups of patients have experienced longer waiting times.

Table Details:

The above overview provides most readers with a quick look at some of the statistics that help describe an OPO and its Donation Service Area (DSA). The following section, for the more interested reader, provides a more detailed accounting of each table and how figures are defined and calculated.

Table 1: From the 98 donors mentioned above having organs recovered by Pacific Northwest Transplant Bank (ORUO), 181 kidneys were recovered, and 91.2 percent of these were transplanted (165), as compared to 83.8 percent of kidneys that were transplanted nationally (11,602 of 13,849). Additionally, 90 livers were recovered (91.1 percent transplanted compared to 90.5 percent nationally), 22 hearts were recovered (90.9 percent transplanted compared to 98.8 percent nationally), and 38 lungs were recovered (100.0 percent transplanted compared to 96.9 percent nationally).

Table 2 shows the transplant location of each organ recovered by Pacific Northwest Transplant Bank (ORUO) . Centers in this DSA are shown individually; exported organs are counted as having been transplanted at "Other Centers" at the bottom of the table. For example, from July 1, 2005 to June 30, 2006, 164 kidneys, 82 livers, 19 hearts, and 38 lungs recovered by this OPO were transplanted. Of these organs, 127 kidneys, 56 livers, 12 hearts, and 0 lungs were transplanted at centers within this DSA. The remaining 37 kidneys, 26 livers, 7 hearts, and 38 lungs recovered by this OPO were exported to centers in other DSAs.

Table 3 -- and the concepts of risk-adjusted comparison, donation rates, and notification rates -- is described above in the General Overview. In addition, Table 3 also shows a second method of calculating expected rates that includes adjustments for the expected notification rate in addition to those for hospital characteristics. Using this method, the expected donation rate for Pacific Northwest Transplant Bank (ORUO) is 57.9 donors per 100 eligible deaths. Comparing the observed rate of 74.6 at Pacific Northwest Transplant Bank (ORUO) to this expected rate, the p-value of 0.028 indicates that this difference is also statistically significant. Similar information by organ is also displayed in this table. Additionally, these measures are shown by hospital in Table 3A.

Table 4 describes the characteristics of donors for each of the past two years, comparing this DSA to the nation as a whole. For example, Pacific Northwest Transplant Bank (ORUO) had 98 donors in the past year, of which 88.8 percent were White, and 2.0 percent were Black, and 6.1 percent were non-White Hispanic/Latino. As a comparison, 67.8 percent of donors nationally were White, and 15.3 percent were Black, and 14.0 percent were non-White Hispanic/Latino during the same period. Similar comparisons may be made for other demographic characteristics.

Table 5 contains similar information for each type of organ donated for the past two years. Pacific Northwest Transplant Bank (ORUO) had 169 kidney donors, 168 liver donors, and 50 heart donors. Of the kidney donors, 51.5 percent had type "O" blood, where as 51.8 percent of liver donors and 62.0 percent of heart donors had this blood type. Only 4.7 percent of kidney donors had type "AB" blood, compared to 4.8 percent of liver donors and 2.0 percent of heart donors having this blood type.

Table 6 measures how quickly patients receive transplants when waitlisted at centers within this DSA. This table is described above in the General Overview.

Table 7 shows the time it takes for a given percentage of patients on the waiting list for each organ within Pacific Northwest Transplant Bank (ORUO) at this facility to receive a transplant. This is the "time-to-transplant" among all wait-listed patients, including those who never receive a transplant. Half of the patients placed on the kidney waiting list at centers within this DSA had received a transplant as of 12.6 months after listing; in the nation it took 38.3 months to reach the same fraction. The other half of the patients were either still waiting or removed from the waiting list, for reasons including death. Similarly, half of the patients placed on the liver waiting list at centers within this DSA had received a transplant as of 48.9 months after listing compared to 24.2 months to reach the same percentage in the nation.

Half of the patients placed on the heart waiting list at centers within this DSA had received a transplant as of 2.6 months after listing; in the nation it took 6.7 months to reach the same fraction. The other half of the patients were either still waiting or removed from the waiting list, for reasons including death.

Table 8 contains information on the characteristics of transplant recipients in the various centers in this DSA. These data are arranged such that each organ is displayed in a separate table.

Table 9 shows the counties within the Pacific Northwest Transplant Bank (ORUO) service area for each year from 2003 to 2006. Included are counties containing hospitals that contribute organs to the OPO, as well as other counties that are considered part of the service area by CMS. See the footnotes to this table for more information about defining this county list.