From Harvard Medical School
Improved procurement could more than double availability of life-saving transplant organs
Yet study finds that even with greater efficiency, supply of organs will not meet transplant demand BOSTON, MA – Last year, fewer than 6,200 people in the United States donated organs though more than 80,000 waited for organ transplantations. Each day, an average of 17 people die while waiting for a transplant.
Even though the need for transplantable organs far outweighs the supply, the number of organs donated could be more than doubled--saving thousands of lives every year--if the procurement process were improved. These findings by researchers from Harvard Medical School, Boston University, and the Institute for Healthcare Improvement appear in the summer issue of Health Care Financing Review published this week.
Although millions of people across the country are registered donors, only two percent of them annually suffer brain death and meet the other medical requirements for being a cadaveric donor. The U.S. Department of Health and Human Services (HHS) suggests that the number of actual donors may be further limited by organ procurement organizations (OPOs) that do not utilize the most efficient practices.
"We needed to know if we have a supply of potential donors who can meet the demand for organs," said Edward Guadagnoli, first author on the study and an associate professor of health care policy at Harvard Medical School. "We didn't know until we used a statistical model to estimate that number." The researchers determined that the number is about 17,000 potential donors each year.
OPOs coordinate the organ donation process and match potential donors to recipients. They also deal directly with the potential donor's family to get consent for donation. Organ donation usually comes at a difficult time for families, and the way an OPO addresses the situation can mean the difference between saving a life through transplantation and losing a potential donor. Family resistance to organ donation is the primary reason that potential donors do not donate.
According to the study, OPOs have an efficiency rate of between 20 and 80 percent, with an average rate of about 34 percent. In other words, the country's medical industry is using only one third of the potential donors.
Even with 100 percent OPO efficiency, Guadagnoli says, there still would not be enough potential donors to supply the current demand for organs.
"There are simply not enough. We figure there are about 17,000 potential donors a year, but the current need is too great. Every year, the number of people waiting increases," Guadagnoli says.
On September 9 and 10, HHS led the first of three seminars focused on increasing the number of actual donors. HHS Secretary Tommy Thompson is calling for OPOs to increase their efficiency to 75 percent, a goal that Guadagnoli says is high, but may be possible.
Other organ sources include living donors and xenotransplantation--the transplantation of an animal organ into a human. Yet cadaveric donations still provide almost 75 percent of transplanted organs. Guadagnoli says there is nothing on the medical horizon that can replace or significantly supplement this organ source.
Edward Guadagnoli, Ph.D.
Associate Professor of Health Care Policy
Department of Health Care Policy
Harvard Medical School.
Edward Guadagnoli, Ph.D. is an Associate Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School. He is also an Assistant Epidemiologist in the Department of Medicine at Brigham and Women's Hospital.
Dr. Guadagnoli's research focuses on evaluating the quality and outcomes of health care, examining access to health care, and evaluating health care interventions. His work in the area of cancer care has touched on all of these topics. He has studied the quality of and access to cancer care in various regions of the United States and he has led an evaluation of an intervention to improve discussion of treatment options between patients and their surgeons. He is currently leading a study to examine how well publicly available data such as Medicare billing data and hospital discharge data can characterize the quality of care provided to women with breast cancer. As part of another project, he is studying the factors associated with prescription of and compliance with tamoxifen therapy in patients diagnosed with early-stage breast cancer. He is also a member of the Cancer Care Outcomes Research & Surveillance (CanCORS) Consortium, which is studying the quality of care provided to patients with lung or colorectal cancer treated across the United States.
Since arriving at Harvard, Dr Guadagnoli has been involved in several large-scale projects to study the quality of care for patients with cardiovascular disease. His work in this area focuses on understanding the factors related to variation in practice across geographic areas and on determining how variation in practice is associated with the quality of care provided to patients. He recently completed an evaluation of the quality of cardiac care services provided by the Veterans Health Administration. He is also involved in a project to develop quality indicators for the care of patients with acute myocardial infarction, congestive heart failure, or hypertension.
As part of his work in the areas of quality of care assessment and evaluation of health care interventions, Dr. Guadagnoli is leading an evaluation of the Health Disparities Collaboratives program, which is an effort of the Bureau of Primary Health Care to improve the quality of care in the nation's community health centers and to reduce health disparities. This evaluation will involve 60 community health centers from throughout the country and nearly 10,000 patients with diabetes, asthma, or hypertension.
A more recent interest involves evaluating the effect of managed care on the quality of health care. Dr Guadagnoli recently reported that the delivery of appropriate care for acute myocardial infarction, as defined by established standards, varies for those Medicare beneficiaries enrolled in managed care versus those who receive care in the traditional fee-for-service setting. He is currently leading a study to determine which features of managed care are associated with the quality of care provided to patients with diabetes and hypertension and he is leading several studies that will examine the association between the level of managed care in a market and the quality of care for patients with acute myocardial infarction or cancer.
Dr. Guadagnoli is also interested in understanding how to improve the rate of organ donation in the United States. This work has focused on assessing the process of making a donation request in the hospital, but he has also studied the public's and providers' attitudes and beliefs about donation. He recently completed a study that estimated the organ donor potential in the United States and that evaluated the performance of the nation's Organ Procurement Organizations.
Dr. Guadagnoli has served on review panels for the National Institutes of Health and the Agency for Healthcare Research and Quality (AHRQ). He is currently a member of AHRQ's Health Services Research Dissemination and Implementation Review Committee and a member of the National Cancer Institute's Expert Liaison Group of the Breast Cancer Surveillance Consortium . During 1994-1996 he was a Picker/Commonwealth Scholar studying various aspects of patient participation in decision making about medical treatment. Dr. Guadagnoli received his B.A. degree from Providence College and M.A. and Ph.D. degrees in experimental psychology from the University of Rhode Island.
HARVARD MEDICAL SCHOOL
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