Bollinger R R, Heinrichs D R, Seem D L, Rosendale J D, Johnson K S
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Clin Transplant. 2001;15 Suppl 6:16-21. doi: 10.1034/j.1399-0012.2001.00003.x.
There are currently 59 organ procurement organizations (OPOs) in the United States which serve their assigned geographic areas with variable productivity. Knowledge of organizational characteristics, programs and practices of more successful OPOs may be useful to increase the productivity of less successful OPOs. A preliminary survey of all OPO executive directors in the United States ascertained the most important beneficial and detrimental factors affecting their success. Site visits were then conducted at OPOs based on a selection process utilizing population size, geographic location, minority population, donors per million population and donors per thousand deaths among potential donors. All OPOs were categorized and the highest ranking OPOs in each of seven categories, based on 4 years of national data, were selected for the site visits. Regression analysis and correlation analysis using Pearson's product-moment correlation were performed. The survey to identify the important factors was returned by 47 (77%) of 61 OPOs existent in 1999. The most important beneficial factors identified by responding OPOs were adequate staffing and experience, allocation of responsibilities, hospital development and leadership. The most important detrimental factors were inadequate staffing and experience, poor donor hospital/transplant center/ OPO relationships and failure in the consent process. Site visits of the highest-ranking OPOs demonstrated all had respected, experienced leadership focused on the donation process; efficient mechanisms for resolving allocation or transplant center conflicts; systems for monitoring activity and tracking outcomes; excellent communication between OPO and transplant centers; open internal communication at all levels of the OPO; immediate, on-site response to vascular donor referrals; and volunteer support of public and/or professional education. Regression and correlation analysis demonstrated that as minority population increases, OPO performance declines (P < 0.03). Moreover, independent OPOs were associated with poorer performance regardless of minority population (P < 0.05). All of the successful OPOs visited had strong leadership, excellent donor hospital and transplant center relationships, well-developed communication and innovative methods to deal with their minority populations. Application of these practices within all OPOs could significantly enhance organ donation.
美国目前有59个器官获取组织（OPO），它们在各自指定的地理区域开展工作，工作效率各不相同。了解更成功的OPO的组织特征、项目和做法，可能有助于提高不太成功的OPO的工作效率。对美国所有OPO执行董事进行的初步调查，确定了影响其成功的最重要的有利和不利因素。然后，根据人口规模、地理位置、少数族裔人口、每百万人口的捐赠者数量以及潜在捐赠者中每千例死亡的捐赠者数量等选择标准，对OPO进行实地考察。所有OPO都进行了分类，并根据4年的全国数据，从七个类别中的每一类中挑选出排名最高的OPO进行实地考察。采用Pearson积差相关进行回归分析和相关分析。1999年存在的61个OPO中有47个（77%）回复了关于确定重要因素的调查。回复的OPO确定的最重要的有利因素是人员配备充足和经验丰富、职责分配、医院发展和领导力。最重要的不利因素是人员配备不足和经验欠缺、捐赠医院/移植中心/OPO关系不佳以及同意过程失败。对排名最高的OPO的实地考察表明，所有这些OPO都有受尊重且经验丰富的专注于捐赠过程的领导力；解决分配或移植中心冲突的有效机制；监测活动和跟踪结果的系统；OPO与移植中心之间的良好沟通；OPO各级内部的开放沟通；对血管捐赠者转诊的即时现场响应；以及对公众和/或专业教育的志愿者支持。回归和相关分析表明，随着少数族裔人口的增加，OPO的表现会下降（P < 0.03）。此外，无论少数族裔人口情况如何，独立的OPO与较差的表现相关（P < 0.05）。所有接受考察的成功OPO都有强大的领导力、良好的捐赠医院和移植中心关系、完善的沟通以及处理少数族裔人口问题的创新方法。在所有OPO中应用这些做法可以显著提高器官捐赠率。
