TY - JOUR
T1 - Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield
AU - Wey, Andrew
AU - Valapour, Maryam
AU - Skeans, Melissa A.
AU - Salkowski, Nicholas
AU - Colvin, Monica
AU - Kasiske, Bertram L.
AU - Israni, Ajay K.
AU - Snyder, Jon J.
N1 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/8
Y1 - 2018/8
N2 - Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. To investigate these issues, offer acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) were estimated using offers from donors recovered July 1, 2016, and June 30, 2017. Logistic regressions estimated the association of DSA-level offer acceptance ratios with donor yield and local placement of organs recovered in the DSA. Competing risk methodology estimated the association of program-level offer acceptance ratios with incidence and rate of waitlist removals due to death or becoming too sick to undergo transplant. Higher DSA-level offer acceptance was associated with higher yield (odds ratios [ORs]: lung, 1.041.111.19; heart, 1.091.211.35) and more local placement of transplanted organs (ORs: lung, 1.011.121.24; heart, 1.471.691.93). Higher program-level offer acceptance was associated with lower incidence of waitlist removal due to death or becoming too sick to undergo transplant (hazard ratios [HRs]: heart, 0.800.860.93; lung, 0.670.750.83), but not with rate of waitlist removal (HRs: heart, 0.910.981.06; lung, 0.890.991.10). Heart and lung offer acceptance practices affected numbers of transplanted organs and contributed to program-level variability in the probability of waitlist mortality.
AB - Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. To investigate these issues, offer acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) were estimated using offers from donors recovered July 1, 2016, and June 30, 2017. Logistic regressions estimated the association of DSA-level offer acceptance ratios with donor yield and local placement of organs recovered in the DSA. Competing risk methodology estimated the association of program-level offer acceptance ratios with incidence and rate of waitlist removals due to death or becoming too sick to undergo transplant. Higher DSA-level offer acceptance was associated with higher yield (odds ratios [ORs]: lung, 1.041.111.19; heart, 1.091.211.35) and more local placement of transplanted organs (ORs: lung, 1.011.121.24; heart, 1.471.691.93). Higher program-level offer acceptance was associated with lower incidence of waitlist removal due to death or becoming too sick to undergo transplant (hazard ratios [HRs]: heart, 0.800.860.93; lung, 0.670.750.83), but not with rate of waitlist removal (HRs: heart, 0.910.981.06; lung, 0.890.991.10). Heart and lung offer acceptance practices affected numbers of transplanted organs and contributed to program-level variability in the probability of waitlist mortality.
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - clinical research/practice
KW - organ acceptance
KW - organ procurement and allocation
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U2 - 10.1111/ajt.14885
DO - 10.1111/ajt.14885
M3 - Article
C2 - 29673099
AN - SCOPUS:85047438455
SN - 1600-6135
VL - 18
SP - 2061
EP - 2067
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -