Kidney Transplant KPI Monitoring From OPO: A Strategy for Benchmarking and Quality Improvement in Rio de Janeiro State

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Abstract

Introduction

In the last 7 years, the state of Rio de Janeiro has been improving organ donation rates through different strategies implemented by the OPO (PET, Programa Estadual de Transplantes). The total number of kidney transplants increased 95% between 2009 and 2016, while kidney transplants from deceased donors increased by 189%.

Introduction

The next step of OPO’s policies and practices is to improve quality and surveillance of organs allocated and positively impact transplant results. The OPO Transplant Monitoring Division has been created to follow up key performance indicators (KPI) from transplant centers and share this information among them, to compare results and look for the best practices through this benchmarking strategy.

Methodology

The KPI were defined in a technical meeting with OPO Directors Board and Kidney Transplant Centers Chiefs: Expanded Criteria Donor (ECD) acceptance, age range of recipients, average of waiting time for transplant, average length of stay, cold ischemia time, immunosuppressive medication of choice, delayed graft function (DGF), graft loss and mortality.

Methodology

A descriptive analysis with a qualitative and quantitative approach was made in the chart of 265 recipients from deceased donors in 5 transplant centers in the year of 2016 (97% of kidney deceased transplants). All donors were procured by PET and transplants performed with kidneys recovered from any other OPO were not analyzed.

Result

From all transplants, 51% were performed in a single center, a public hospital that also had the greatest acceptance of ECD donors (38,5%). The only private center in the sample performed 5% of kidney deceased transplants, had the lowest acceptance of ECD donors (7,69%) and also the highest DGF rate (69%). In the children transplant center, 45% of procedures were performed within 6-12h of cold ischemia time in this hospital, and had the lowest DGF rate among all transplant centers (12%). Length of stay varied between 14 days (children transplant center) and the university hospital (19 days).

Conclusion

The data collected from the OPO Transplant Monitor Division allowed for the first time in our country, from an OPO perspective, a deep analysis of the main kidney transplant center’s KPI. If carefully discussed and continuously analyzed from now on, this data may improve organ allocation and utilization, providing the best practices among professionals and institutions. It may also influence future policies and the financial aspects of our system.

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