Evolution of quality at the Organ Center of the Organ Procurement and Transplantation Network/United Network for Organ Sharing

Progress in Transplantation, Sep 2009 by Brown, Roger S, Belton, A Matthew, Martin, Judith M, Simmons, Dee Dee, Taylor, Gloria J, Willard, Ellie

One of the goals of the Organ Center of the Organ Procurement and Transplantation Network/United Network for Organ Sharing is to increase the efficiency of equitable organ allocation in the United States. Recognizing the ever-growing need for organ donors and transplants, leaders at the Organ Center increased its commitment to quality improvement initiatives through the development of a quality management team in 2001 . The Organ Center began to focus on ways to capture data on processes and pinpoint areas for improvement. As the collection and analysis of data evolved, the Organ Center embraced formal quality standards, such as improvement cycles. Using these cycles, the Organ Center has seen significant improvement. One initiative involving lifesaving heart, lung, and liver placement showed success by doubling the Organ Center's organ placement rate. Another project involving the validation of donor information demonstrated that the accuracy of organ allocation can be improved by 5% on a consistent basis. As stewards for the gift of life and leaders in organ allocation, the Organ Center uses continuous quality improvement to achieve the goal of increasing the efficiency of equitable organ allocation. (Progress in Transplantation. 2009;19:221-226)

From its early begirinings in 1982 as the Kidney Center, the Organ Center of the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) has grown to provide service for the 50 states and the Commonwealth of Puerto Rico. As more organs were successfully transplanted, the name was changed from the Kidney Center to the Organ Center in 1984. The Organ Center has provided continuous service for the past 27 years.

The Organ Center is housed within UNOS, a nonprofit organization that operates the OPTN by contract with the Health Resources and Services Adrninistration, within the federal Department of Health and Human Services. UNOS was awarded the OPTN contract in 1986 and has remained me contractor through a number of competitive renewals. Under the OPTN contract, UNOS maintains the national computerized database of die transplant candidate waiting list and organ-matching system that comprises UNet and DonorNet.1

Available 24 hours a day, 365 days a year, the Organ Center assists the US transplant community by

* Placing deceased donor organs for transplantation

* Arranging transportation for shared organs

* Providing resource support to the US transplant community about national organ sharing policies and processes

* Running and transmitting the computerized donor/recipient match results'

The Organ Center is staffed by 17 full-time organ placement specialists, 1 data and operations specialist, and 3 managers. The Organ Center workday is divided into two 12-hour shifts and is typically staffed with 3 organ placement specialists per shift and 1 additional organ placement specialist on call. Having two 12-hour shifts allows donor and organ placement information to be transferred among staff only twice per day, limiting the opportunity for miscommunication.2 An electronic shift report ensures that all placement efforts are communicated to the next shift. All phone calls that come through the Organ Center are digitally recorded for quality assurance.

In 2001, a quality management team was formed at the Organ Center. The team's primary mission is to audit 100% of donor cases at the Organ Center, ensuring adherence to OPTN/UNOS policies and Organ Center procedures. The team is housed in the Evaluation and Quality Department within UNOS, separate from the Organ Center to avoid any conflict of interest. The quality management team provides bimonthly updates to Organ Center management and staff on donor case performance. These updates are used by management to monitor both the individual and organizational trends. Since the inception of the quality management team, the allocation of more than 50000 unique, donated organs has been reviewed for accuracy. The current quality management team consists of 4 staff members.

Another effort to ensure quality began in June 2004 when the Organ Center and the quality management team, along with several other departments at UNOS, became International Organization for Standardization (ISO) 9001:2000 certified- a certification specific to quality management systems.3 The most recent ISO surveillance audit was in July 2008 and resulted in a perfect audit score. Together, the Organ Center and quality management staff have more than 130 years of transplant experience, and several staff members each have more than a decade of experience.

Improvement Initiatives for the Organ Placement Process

Before the current method of organ placement via electronic organ offer notification through DonorNet, Organ Center staff telephoned transplant centers to inform them of an organ offer. Organ Center staff either verbally reviewed a donor chart with on-call transplant center staff or faxed the donor chart to the center. This process could be extremely lengthy. In 2005, the Organ Center made 42 900 unique organ offers to transplant centers in 17 122 hours of total organ placement time for an average rate of 2.5 organ offers per organ per hour.