Evaluation of the Stability of Organ Procurement Organization Performance Metrics.

In 2020, the Centers for Medicare and Medicaid Services (CMS) updated the Organ Procurement Organization (OPO) Conditions for Coverage, redefining deceased donor potential (DDP) as all inpatient deaths among patients 75 or younger with a primary cause of death consistent with organ donation, also called CALC (Cause, Age, and Location Consistent with donation). This study evaluates CALC performance metrics using 2018-20201 data from Centers for Disease Control (CDC) mortality data (currently used by CMS) and Agency for Healthcare Research and Quality's State Inpatient Databases (SID). We analyzed yearly performance variability, compared data sources, and examined the impact of CALC versus CALC-adjusted, which excludes donors with potential contraindications. There was significant year-to-year variability in CDC CALC tiers, with up to 40% of OPOs changing tiers annually. Between 20-43% of OPOs changed CALC performance tiers using SID compared to CDC. Additionally, while CALC and CALC-adjusted rates were correlated, 11-29% of OPOs changed performance tiers with adjustment. These differences identify opportunities for potential changes to create more stable and consistent OPO performance measures. Future research to refine these metrics to ensure they support the goal of continuing improvement in OPO performance to maximize organ donation and transplant rates is important.