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Liver Transplantation
Article . 2015 . Peer-reviewed
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Liver sharing and organ procurement organization performance

Authors: Sommer E, Gentry; Eric K H, Chow; Allan, Massie; Xun, Luo; David, Zaun; Jon J, Snyder; Ajay K, Israni; +2 Authors

Liver sharing and organ procurement organization performance

Abstract

Whether the liver allocation system shifts organs from better performing organ procurement organizations (OPOs) to poorer performing OPOs has been debated for many years. Models of OPO performance from the Scientific Registry of Transplant Recipients make it possible to study this question in a data‐driven manner. We investigated whether each OPO's net liver import was correlated with 2 performance metrics [observed to expected (O:E) liver yield and liver donor conversion ratio] as well as 2 alternative explanations [eligible deaths and incident listings above a Model for End‐Stage Liver Disease (MELD) score of 15]. We found no evidence to support the hypothesis that the allocation system transfers livers from better performing OPOs to centers with poorer performing OPOs. Also, having fewer eligible deaths was not associated with a net import. However, having more incident listings was strongly correlated with the net import, both before and after Share 35. Most importantly, the magnitude of the variation in OPO performance was much lower than the variation in demand: although the poorest performing OPOs differed from the best ones by less than 2‐fold in the O:E liver yield, incident listings above a MELD score of 15 varied nearly 14‐fold. Although it is imperative that all OPOs achieve the best possible results, the flow of livers is not explained by OPO performance metrics, and instead, it appears to be strongly related to differences in demand. Liver Transpl 21:293–299, 2015. © 2015 AASLD.

Keywords

Health Services Needs and Demand, Tissue and Organ Procurement, Waiting Lists, Process Assessment, Health Care, Severity of Illness Index, Health Services Accessibility, Tissue Donors, United States, Decision Support Techniques, Liver Transplantation, End Stage Liver Disease, Treatment Outcome, Catchment Area, Health, Residence Characteristics, Models, Organizational, Humans, Healthcare Disparities, Needs Assessment, Quality Indicators, Health Care

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
22
Top 10%
Top 10%
Top 10%
bronze