1Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA. 2 Division of Transplant Surgery, Massachusetts General Hospital, Boston, MA. 3 Harvard Medical School, Boston, MA. 4Section of Transplant Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Transplantation. 2016 Jun;100(6):1349-55. doi: 10.1097/TP.0000000000000979.
Organ procurement organizations (OPOs) are currently evaluated on donation rates and number of organs per donor. However, there is significant variability in market characteristics which affect transplant programs' donor organ acceptance practices and OPOs' ability to successfully place higher risk organs. The impact of transplant market characteristics on OPO performance metrics has not been evaluated.
The OPO performance measures were correlated annually with the Herfindahl Hirschman Index, a standard measure of market competition for centers within the OPO donor service areas from 2003 to 2011.
More competitive donor service areas were associated with increased number of donors (P = 0.01) and eligible deaths (P < 0.001). Market competition was associated with increased use of high Donor Risk Index for kidney (P = 0.03) and liver (P = 0.01) allografts. The OPOs with increased competition in liver transplant also were noted to have a higher donor conversion rate (P < 0.001), more donors per million population (P < 0.001), and a higher utilization rate for liver allografts (P = 0.007).
These data suggest that proposals to increase district size to increase competition among transplant programs could result in improved organ utilization over time by incentivizing the use of marginal donor organs and increasing access to transplantation.
器官获取组织（OPO）目前的评估标准是捐赠率和每位捐赠者的器官数量。然而，市场特征存在显著差异，这些差异会影响移植项目的供体器官接受实践和 OPO 成功放置高风险器官的能力。移植市场特征对 OPO 绩效指标的影响尚未得到评估。
从 2003 年到 2011 年，每年将 OPO 绩效指标与赫芬达尔-赫希曼指数相关联，该指数是 OPO 供体服务区内中心市场竞争的标准衡量指标。
竞争更激烈的供体服务区与更多的捐赠者（P = 0.01）和符合条件的死亡人数（P <0.001）相关。市场竞争与使用更高的肾脏（P = 0.03）和肝脏（P = 0.01）供体风险指数供体移植物的增加有关。在肝脏移植中竞争加剧的 OPO 还被发现具有更高的供体转化率（P <0.001）、每百万人口更多的捐赠者（P <0.001）和更高的肝脏移植物利用率（P = 0.007）。
这些数据表明，增加地区规模以增加移植项目之间竞争的提议可能会随着时间的推移通过激励使用边缘供体器官和增加移植机会来提高器官利用率。
