Variation Across Organ Procurement Organizations in Deceased-Donor Kidney Offer Notification Practices

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-11-14 DOI:10.1111/ctr.70024

David C. Cron, Arnold E. Kuk, Layla Parast, S. Ali Husain, Vanessa M. Welten, Miko Yu, Sumit Mohan, Joel T. Adler

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引用次数: 0

Abstract

Introduction

How offer notifications are distributed early in the kidney allocation timeline, including how widely they are offered, is unclear. A better understanding of offer notification practices across organ procurement organizations (OPOs) may identify opportunities for more efficient allocation.

Methods

We merged the Scientific Registry of Transplant Recipients potential transplant recipient file with additional offer notification time stamps to identify 54 631 deceased-donor kidney match runs from 2017 to 2023. Offer notifications for a given match run are sent to candidates/centers in “batches.” We quantified the number of offers in the initial batch—which theoretically reflects the OPO's initial estimate of how widely a kidney should be offered—and compared this metric across OPOs.

Results

Kidneys were offered to a median of 14 candidates (IQR 9–38) in the first batch of notifications, and this varied across OPOs from 3 to 746 candidates per initial batch. Batch size at the OPO-level did not correlate with rank at kidney placement or OPO nonuse rate. OPOs in the highest quartile of batch size sent more offers (median 100) than presumably necessary to place kidneys (median rank at placement 21), and OPOs in the lowest quartile of batch size sent fewer offers (6) than needed to place kidneys (rank at placement 19).

Conclusions

Offer notification practices vary widely across OPOs, and many OPOs offer kidneys far more widely than necessary for placement. Optimization of offer notification practices may reduce unnecessary communications. Further research into allocation processes is needed to identify opportunities to improve efficiency of allocation for OPOs and transplant centers.

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不同器官获取组织在已故捐肾者供肾通知做法上的差异。

导言：目前尚不清楚在肾脏分配时间表的早期如何分发募捐通知，包括募捐范围有多广。更好地了解器官获取组织（OPO）的肾脏分配通知做法，可以发现提高分配效率的机会：我们合并了移植受者科学登记处的潜在移植受者档案和额外的要约通知时间戳，以确定2017年至2023年期间的54 631次死亡供肾匹配运行。特定配型的配型通知是分 "批次 "发送给候选人/中心的。我们量化了初始批次中提供肾脏的数量--这在理论上反映了OPO对肾脏提供范围的初步估计--并对不同OPO的这一指标进行了比较：在第一批通知中，向14名候选人（IQR为9-38）提供了肾脏，不同OPO的初始批次中，向3至746名候选人提供了肾脏。OPO 一级的批次规模与肾脏安置排名或 OPO 未使用率没有关联。批量规模最高四分位数的 OPO 发出的录取通知（中位数 100 份）多于安置肾脏所需的数量（安置排名中位数 21），而批量规模最低四分位数的 OPO 发出的录取通知（6 份）少于安置肾脏所需的数量（安置排名 19）：结论：各 OPO 的报价通知方式差异很大，许多 OPO 的肾脏报价范围远远超过了肾脏置入所需的范围。优化报价通知方法可以减少不必要的沟通。需要进一步研究分配流程，以确定提高 OPO 和移植中心分配效率的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.