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Organ Transplantation
|
FY
2007 Actual |
FY
2008
Enacted |
FY
2009
Estimate |
FY
2009 +/-
FY 2008 |
BA |
$23,049,000
|
$22,646,000 |
$23,049,000 |
+$403,000 |
Authorizing
Legislation: Sections 371 - 378 of the Public Health
Service Act, (P.L. 98-507 and
P.L. 108-216), as amended.
FY
2009 Authorization |
Expired* |
Allocation
Method |
Contracts,
Competitive Grants and Cooperative Agreements
|
*
Sections 371 - 373 and Section 378 expired September
30, 1993. Sections 374 – 377, as amended by
the Organ Donation and Recovery Act, authorize as
such sums as necessary for FY 2009.
Program
Description and Accomplishments
The National Organ Transplant Act of 1984 (NOTA),
as amended, provides the authorities for the Program.
The primary purpose of the Program is to extend and
enhance the lives of individuals with end-stage organ
failure for whom an organ transplant is the most appropriate
therapeutic treatment. The Program works towards achieving
this goal by providing for a national system, the
Organ Procurement and Transplantation Network (OPTN),
to allocate and distribute donor organs to individuals
waiting for an organ transplant. The allocation of
organs is guided by organ allocation policies developed
by the OPTN with analytic support provided by the
Scientific Registry of Transplant Recipients (SRTR).
In addition to the efficient and effective allocation
of donor organs through the OPTN, the Program also
supports efforts to increase the supply of donor organs
made available for transplantation.
Ideally, an organ would be available for every transplant
candidate at the time the procedure would provide
maximum benefit to the patient. Unfortunately, the
demand for organ transplantation greatly exceeds the
available supply of organs from deceased and living
donors combined (see Figure 1). This trend is anticipated
to continue, unless there is a major breakthrough
in transplantation technology that will obviate the
need for donor organs or the incidence of end-stage
organ failure in the U.S. dramatically declines. This
supply and demand imbalance is vividly evidenced by
the 94,000 patients who were waiting for an organ
transplant at the end of 2006. This number continues
to increase as almost 98,000 patients were waiting
for an organ transplant as of January 2008. Tragically,
6,700 individuals died, approximately 18 per day,
in 2006 while waiting for a donor organ.
Figure 1:
This graph shows trends from 1993 to 2006 in the
number of patients on the transplant waitlist, the
number of transplants performed from deceased donors
only, and the number of transplants from living as
well as deceased donors. The number of patients on
the transplant waitlist has grown steadily from about
30,000 in 1993 to over 94,000 in 2006. While the number
of transplants performed has also grown over this
time period, it has not grown as rapidly as the waitlist,
leading to what is characterized on the graph as an
“organ gap”.
In 2006, the most recent year for which program data
are available, the Program demonstrated continued
improvement in meeting its two long-term performance
goals. The Program goals are summarized by two overarching
measures: (1) by FY 2013, increase the number of deceased
donor organs transplanted to 42,800, an increase of
110 percent over the 2003 baseline, and (2) by FY
2013, increase the total expected life-years gained
for kidney transplant recipients in the first five
years after the transplant to 8,543 compared to what
would be expected for these recipients had they remained
on the waiting list. These Program goals were established
in FY 2004.
The long-term goal of 42,800 deceased organs transplanted
is based on converting an increasing percentage of
the estimated annual number of deaths that meet ‘eligible
donor’ criteria to actual donors. An ‘eligible
donor’ is defined as any heart-beating individual
meeting the criteria for neurological death, age 70
years or under, who has not been diagnosed with exclusionary
medical conditions published by the OPTN. Beginning
in September 2002, the OPTN started collecting this
information from organ procurement organizations (OPOs)
on a monthly basis. Based on these newly collected
data, the number of eligible donors was estimated
to be 12,000 in early 2004, when the performance goals
were established. It took approximately two years
to resolve definitional and data reporting issues
to achieve an accurate accounting of the number of
eligible donors. As the eligible donor data stabilized
in late 2004, it became apparent that the number of
eligible donors was closer to 11,000 and not the 12,000
used to develop the performance goals.
The Program has made impressive and sustained increases
in the number of deceased donor organs transplanted.
In 2003, the baseline year used for establishing the
performance goals, 20,392 deceased donor organs were
transplanted. In 2006, 24,461 deceased donor organs
were transplanted, an increase of 20.3 percent above
the 2003 baseline. The annual rate of growth between
the end of 2003 and the end of 2006 was approximately
6.3 percent. In contrast, the annual rate of growth
for the period between the end of 1993 and the end
of 2003 was 2.5 percent. While the Program only met
or exceeded its performance goal for this measure
in FY 2004, the Program would have exceeded its performance
targets in all three years if the targets had been
properly calculated using the more accurate 11,000
number of eligible deaths.
The sustained improvements in the number of deceased
donor organs transplanted can be largely attributed
to the highly successful series of Breakthrough Collaboratives
that began in 2003. The Breakthrough Collaboratives
apply a proven methodology, created by the Institute
for Healthcare Improvement (IHI), to successfully
generate and sustain improvements in healthcare systems.
The initial Collaborative, the Organ Donation Breakthrough
Collaborative, was initiated in September of 2003.
The goal of this Collaborative is to increase the
organ donation conversion rate from 50 percent to
75 percent by 2013. A conversion rate is the number
of organ donors meeting eligible donor criteria divided
by the number of deaths that meet eligible donor criteria.
HRSA partnered with the Nation’s 58 OPOs and
donor hospitals having the highest number of eligible
donors to test and implement changes to achieve this
goal. As a result of this effective collaboration,
the conversion rate increased to 64 percent by the
end of 2006. Figure 2 illustrates the progress made
towards closing the gap between the number of donors
meeting eligible donor criteria and the number of
deaths meeting eligible donor criteria. Figure 2 also
illustrates that the number of eligible donors has
declined from 11,417 in 2002 to 10,978 in 2007, a
decline of 3.9 percent.
|
Figure
2:
This graph shows trends from 2002 to 2006 in the
number of deceased individuals who meet eligible donor
criteria and in the number of donors that meet eligible
donor criteria. The graph shows that a larger percentage
of deceased individuals who could donate orgrans are
currently becoming organ donors (up from 50% in 2002
to 64% in 2006).
A major factor in increasing the number of organs
transplanted is increasing the number of deceased
donors. In 2006, the Program continued to make dramatic
gains in the number of deceased donors. There were
8,024 deceased donors in 2006, an increase of 5.7
percent above the record-breaking number of 7,593
deceased donors in 2005. This continues a trend that
began in 2004, the year after the Organ Donation Breakthrough
Collaborative began. In 2004, there were 7,150 deceased
donors, an unprecedented increase of 10.7 percent
above the 6,457 number of deceased donors in 2003.
This achievement continued into 2005 with 7,593 deceased
donors, a 6.2 percent increase in the number from
2004.
The Organ Donation Breakthrough Collaborative was
followed by the Organ Transplantation Breakthrough
Collaborative beginning in October 2005. The purpose
of this Collaborative is to increase the average number
of organs transplanted from every deceased donor from
approximately 3.20 to 3.75 by 2013. When the goals
of the Organ Donation and Transplantation Collaboratives
are achieved in 2013, approximately 35,000 deceased
donor organs will be transplanted annually. This projection
is consistent with the revised performance goal based
on 11,000 eligible donors.
While additional increases can be achieved in the
number of deceased donor organs made available for
transplantation, there is an acknowledged upper limit
to the number of deaths occurring each year that may
result in organ donation. As mentioned previously,
data from the OPTN indicate that approximately 11,000
of the 825,000 in-hospital-annual deaths meet the
current ‘eligible donor’ criteria. Due
to a number of factors, including a downward trend
in the number of deaths that occur in hospitals, the
aging of the population, and increases in chronic
comorbidities that may exclude a deceased individual
from becoming an organ donor, HRSA believes that the
11,000 ‘eligible donor’ upper limit may
hold steady or actually decline in the coming years.
A decrease between 2005 and 2006 is evident in Figure
2. If this trend continues, it will be increasingly
difficult for the Program to meet the growing demand
for deceased donor organs.
The Program also is making progress towards achieving
its second long-term goal of increasing the total
expected life-years gained for kidney transplant recipients
in the first five years after transplant. The goal
is to increase the total lifetime benefit achieved
by all transplant recipients to 8,543 years by 2013.
This target represents the expected additional life
years gained five-years-post-transplant for the totality
of individuals receiving a kidney transplant in 2013.
As with the first long-term goal of increasing the
number of deceased donor organs transplanted, the
life-years gained goal has annual targets representing
incremental marginal gain (i.e., the gain per each
kidney transplant recipient) and the total gain for
all individuals receiving a kidney transplant in a
given year. Therefore, achieving the long-term goal
is dependent on the marginal improvement gained via
each transplant performed, as well as by increasing
the total number of kidney transplants performed.
For FYs 2004 and 2005, the Program exceeded its performance
goals for both the life-years gained per transplant
and the total gained by all transplants. In 2006,
the Program exceeded its per-transplant goal, yet
fell 2.7 percent short of its goal for total expected
life-years gained (4,913 years, actual vs. 5,048 years,
goal). The reason the Program fell short of its total
expected life-years gained was that the actual number
of kidney transplants performed was less than projected.
Had these original targets been developed using the
11,000 eligible donor benchmark, the total life-years
gained goal would have been met.
Increasing the marginal improvement gained by each
kidney transplant also can be positively influenced
by revising how kidneys are allocated. Over the past
several years, the OPTN has made incremental improvements
to the kidney allocation policy. The current policy
places great emphasis on the amount of time individuals
wait for an organ transplant. The OPTN is currently
in the process of developing a new allocation policy
that will place greater emphasis on the net-lifetime
survival benefit achieved by each kidney transplant.
Depending on the final construct of this allocation
policy, which must balance many issues in addition
to survival benefit, it is anticipated that this new
policy will improve the expected five-year survival
benefit post transplant.
A 2004 PART analysis of the Organ Transplantation
Program produced a rating of Adequate, finding that
the Program has a clear purpose, is operated well,
and meets an important need. The analysis indicated
that the Program was having difficulty in achieving
substantial progress towards its long-term goal of
increasing the number of deceased donor organs transplanted.
Beginning in late 2003, the Program initiated a series
of Breakthrough Collaboratives to rapidly increase
the number of deceased donor organs made available
for transplantation. The Organ Donation and Transplantation
Collaboratives resulted in unprecedented increases
in the number of deceased donor organ transplanted
in CYs 2004 through 2006.
External Evaluation: In addition
to internal monitoring of Program performance, a peer-reviewed
article and a study by the Institute of Medicine have
documented HRSA’s success in increasing the
number of deceased donor organs made available for
transplantation:
-
Sustaining the quality improvement efforts (in organ
donation) is critically important. The Breakthrough
Collaboratives have been instrumental in enhancing
the coordination, processes and practices within
hospitals and OPOs as well as among all of the relevant
organizations and individuals” (Institute
of Medicine (U.S.), Committee on Increasing Rates
of Organ Donation, Organ Donation : opportunities
for action / Committee on Increasing Rates of Organ
Donation, Board on Health Sciences Policy; James
F. Childress and Catharyn T. Liverman, ediors)
-
“Using a controlled pre/post study design,
we compared conversion rates between hospitals that
participated in the first phase of the Organ Donation
Breakthrough Collaborative and controlled hospitals.
The relative increase in the conversion rate in
Collaborative hospitals between the preperiod and
the final months was large—8 percentage points—and
statistically significant” (Howard,
D., Siminaoff, L., McBride, V., Lin, M. 2007. “Does
Quality Improvement Work? Evaluation of the Organ
Donation Breakthrough Collaborative.” Health
Services Research 42-6: 21602173)
Funding
includes costs associated with grant reviews, processing
of grants through the Grants Administration Tracking
and Evaluation System (GATES) and HRSA’s electronic
handbook, and follow-up performance reviews.
Funding History
FY
2004 |
$24,632,000 |
FY
2005 |
$24,414,000
|
FY
2006 |
$23,049,000
|
FY
2007 |
$23,049,000
|
FY
2008 |
$22,646,000
|
Budget
Request
The FY 2009 Request of $23,049,000 is an increase
of $403,000 over the FY 2008 Enacted level. This funding
will continue support for the Organ Transplantation
Program at the FY 2008 Enacted level.
The Program will continue to support Breakthrough
Collaboratives in FY 2009 to make progress towards
achieving a national organ donation conversion rate
of 75% and transplanting an average of 3.75 organs
from each deceased donor. To assist in providing sufficient
transplant capacity to effectively utilize the additional
number of deceased donor organs, the Program will
continue to work with work with OPOs and transplant
programs in FY 2009 to increase the capacity to transplant
35,000 deceased donor organs annually. The Program
will also continue to provide support to States to
implement and improve organ donor registries to allow
individuals who choose to become organ donors to register
their decisions.
The performance goals for the two major program measures
for FY 2009 are:
-
transplant 27,683 deceased donor organs; and
- achieve
5,873 expected life-years gained for the 5-year
period post-transplant for kidney and kidney/pancreas
transplants performed in 2009.
The
following activities will be supported with the requested
funding:
1. Contract to Operate the OPTN ($2.0 million)
The OPTN is the critical nexus between individuals
in need of an organ transplant and donor organs made
available from deceased donors. Organ allocation policies
developed by the OPTN prioritize the allocation of
a deceased donor organ to individuals waiting for
an organ. The policies are under continual review
and refinement to achieve the best outcomes for patients.
Given the critical shortage of organs, these policies
strive to achieve the maximum benefit for the recipient
as well as make the best use of donor organs. A competitive
contracting process to operate the OPTN is held approximately
every five years. UNOS has been the only contractor.
The projected cost of operating the OPTN in FY 2009
is approximately $28.9 million. NOTA limits Federal
support for the OPTN to no more than $2 million annually,
which is approximately 7 percent of the projected
cost of operation. The remaining 93 percent of costs
are paid with revenues generated by fees collected
by the OPTN to register patients on the national donor
waiting list.
2. Contract to Operate the SRTR ($3.9 million)
NOTA provides that the SRTR may be operated under
contract or grant. HRSA has chosen to use a competitive
contracting process to retain greater control over
the work of the SRTR. The initial contract was awarded
to the UNOS in 1987 and operated the SRTR until 2000,
when it was awarded to the Arbor Research Collaborative
for Health (formerly known as the University Renal
Research and Education Association). The major purpose
of the SRTR is to provide analytic support to the
OPTN in the development and evaluation of organ allocation
and other OPTN policies. Additionally, the SRTR provides
analytic support to the Department, including the
Advisory Committee on Organ Transplantation. In an
effort to make information about the performance of
the OPTN more widely available to the public, the
SRTR publishes data about OPO and transplant program
performance and outcomes. This contract is fully-funded
by HRSA.
3. Breakthrough Collaboratives to Increase
the Number of Deceased Donor Organs Made Available
for Transplantation ($3.8 million) HRSA will
continue to support the highly effective Breakthrough
Collaboratives to increase the number of deceased
donor organs made available for transplantation and
the capacity of both the OPO and transplant community
to effectively and efficiently procure more deceased
donor organs and for the transplant program community
to perform more high-quality transplants. Logistics
support to the Collaboratives is provided by contract
that is awarded approximately every 2 years through
a competitive contracting process.
4. Grants to Support Projects to Increase
Organ Donation ($7.95 million)
HRSA awards peer-reviewed grants to public and nonprofit
private entities to: test and replicate new approaches
for increasing organ donation, promote public awareness
about organ donation, and to support development and
improvements of state donor registries.
-
Social and Behavioral Interventions to Increase
Solid Organ Donation
grants to implement and evaluate social and behavioral
strategies to increase family and/or individual
consent for donation.
- Clinical
Interventions to Increase Organ Procurement
grants focusing on clinical activities that begin
after consent is determined or given at time of
death and extend until transplantation. These donor-management-related
activities influence whether a potential donor actually
progresses to become a donor and the number and
quality of organs that may be procured for transplantation.
-
State Donor Registry Support grants
provide assistance to States to initiate and improve
State organ donor registries. State donor registries
are particularly useful in the approximately 47
States that have enacted "first person"
consent laws, where the individual=s decision regarding
organ donation takes precedence over the family's
decision.
- Public
Education Efforts to Increase Organ and Tissue Donation
grants fund the implementation of public education
strategies to increase organ and tissue donation
as evidenced by increased enrollment in State donor
registries or by other means where a State registry
is unavailable.
5. Cooperative Agreement to Provide Support
for Reimbursement of Travel and Subsistence Expenses
Towards Living Organ Donation ($2.0 million)
This 4-year cooperative agreement awarded to the Regents
of the University of Michigan in FY 2006 provides
support for individuals to pay for travel and subsistence
expenses associated with living organ donation. While
the Program does not promote living organ donation
and has no performance goals for increasing the number
of living organ donors, this activity helps increase
access to transplantation, particularly for individuals
of lesser financial means. This grant program was
authorized by the Organ Donation and Recovery Improvement
Act (P.L. 108-216).
6. Activities to Support Public and Professional
Education ($2.7 million) The Program,
independently and in collaboration with the organ
donation and transplant community and other stakeholders,
supports a variety of public and professional education
and outreach efforts designed to increase organ donation.
Included in this category are projects designed to
educate various segments of the population using communications
options appropriate to the message and audience including:
public service announcements broadcast via electronic
media, printed materials, documentaries, educational
programs for the classrooms, national organ donation
events, and Web sites. HRSA initiated a new grant
program in FY 2007 to support innovative strategies
for outreach efforts to encourage public commitment
to organ donation. The Program supports education
initiatives and other activities in collaboration
with the OPTN and with major medical and professional
organizations that are influential in organ and tissue
donation. These activities are designed to increase
the number of organ donors and number of deceased
donor organs made available for transplantation.
7. Advisory Committee on Organ Transplantation
and Interagency Activities to Support Donation and
Transplantation ($0.7 million) The OPTN final
rule (42 CFR ' 121.12) authorizes the creation of
an Advisory Committee on Organ Transplantation (ACOT)
to provide recommendations to the Secretary on issues
related to organ donation and transplantation. The
Program supports the activities of the ACOT including
the logistics for periodic meetings and analytic requirements.
The Program also supports projects in collaboration
with other agencies within the Department related
to organ donation and transplantation including issues
related to: long-term donor and recipient outcomes
related to living organ donation and organ and tissue
safety.
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand The availability of health care,
particularly to underserved, vulnerable and special
needs population |
23.II.A.1 |
Increase the annual number of
organs transplanted in accordance with projections
until 42,800 (1) organs are transplanted in 2013.(Baseline—2003:
20,392) |
21,949 |
23,249 |
25,651 |
24,461 |
27,877 |
Apr-08 |
26,314 |
27,683 |
2013:
42,800 |
23.II.A.4. |
Increase the average number of
organs transplanted per “non-cardiac death” donor
each year by 0.08 until the average of 4.00 (2)
is achieved in 2013. |
3.12 |
3.15 |
3.44 |
3.13 |
3.52 |
Apr-08 |
3.52 |
3.56 |
2013:
4 |
# |
Key Outcomes |
FY 2004 Actual |
FY 2005 Actual |
FY 2006 |
FY 2007 |
FY 2008
Target |
FY 2009
Target |
Out-Year Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand The availability of health care,
particularly to underserved, vulnerable and special
needs population |
23.II.A.5. |
Increase the average number of organs transplanted
per “cardiac death” donor each year by 0.096 until
the average of 3.00 (3) is achieved in 2013. (Baseline—2003:
2.04) |
2.02 |
1.97 |
2.33 |
2.11 |
2.42 |
Apr-08 |
2.39 |
2.46 |
2013:
3 |
23.II.A.6. |
Increase the average number of life-years gained
in the first 5 years after transplantation for
deceased kidney/kidney-pancreas transplants by
0.003 life-years until the goal of 0.436 life-years
gained per transplant is achieved in 2013.(Baseline—2003:
0.406) |
0.433 |
0.44 |
0.415 |
0.42 |
0.418 |
Apr-08 |
0.421 |
0.424 |
2013:
0.436 |
23.II.A.7. |
Increase the total number of expected life-years
gained in the first 5 years after the transplant
for all deceased kidney and kidney-pancreas transplant
recipients compared to what would be expected
for these patients had they remained on the waiting
list. (4) (Baseline—2003: 3,871) |
4,427 |
4,758 |
5,048 |
4,913 |
5,477 |
Apr-08 |
5,543 |
5,873 |
2013:
8,543 |
|
Increase the annual conversion rate of eligible
donors in accordance with projections until a
national conversion rate of 75 percent is achieved
in 2013. (5)(Baseline—2003: 52.2%) |
56.80% |
58.90% |
60.10% |
63.90% |
62.30% |
Apr-08 |
64.40% |
66.50% |
2013:
75.00% |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/Est. |
FY
2009 Target / Est. |
Out-Year
Target / Est. |
Target/
Est. |
Actual |
Target/Est. |
Actual |
Long-Term Objective: Expand
The availability of health care, particularly
to underserved, vulnerable and special needs population |
23.II.A.2. |
Increase the annual number of
“non-cardiac death” donors by 333 until the number
of 9,251 “non-cardiac death” donors is achieved
in 2013. (6) (Baseline 2003: 6,187) |
6,759 |
7,032 |
6,920 |
7,375 |
7,253 |
Apr-08 |
7,083 |
7,317 |
2013:
9,251 |
23.II.A.3. |
Increase the annual number of
“cardiac death” donors by 175 until the number
of 2,018 “cardiac death” donors is achieved in
2013. (7) (Baseline 2003: 268) |
391 |
561 |
793 |
647 |
968 |
Apr-08 |
593 |
658 |
2013:
2,018 |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/Est |
FY
2009 Target / Est. |
Out-Year
Target / Est. |
Efficiency
Measure |
23.E. |
Decrease the total OPTN operating costs per
deceased organ transplanted. (Baseline 2003: $924)
(8) |
$933 |
$986 |
$975 |
$1,012
|
$960 |
May-08 |
$1,098 |
$1,117 |
2011:
$1,185
(9) |
|
Appropriated Amount ($ Millions) |
24.623 |
24.414 |
|
23.049 |
|
23.049 |
22.646 |
23.049 |
|
Notes
(1)
|
This
goal is primarily dependent on converting the
number of eligible donors to actual donors. In
establishing this performance goal in 2004 as
a result of the PART analysis, the Program used
the best newly collected information from the
OPTN that indicated there were approximately 12,000
eligible donors. As a result of refinements in
data collection definitions and more uniform reporting
of data, the best estimate of the current number
of eligible donors is 11,000. It is anticipated
that this number will hold stable and may actually
decline over the next several years. If 11,000
eligible donors in conjunction with the other
changes described in the notes below were used
in the projection of this performance measure,
the target for 2013 will be 33,473 instead of
the current 42,800. Targets for FYs 2008 and 2009
are based on the revised assumptions that are
described in these notes. |
(2) |
An
analysis conducted in association with the Organ
Transplantation Breakthrough Collaborative indicates
that a long-term goal of 3.75 vs. the initial
goal of 4.0 is more realistic. Targets for FYs
2008 and 2009 are based on this assumption. |
(3) |
An
analysis conducted in association with the Organ
Transplantation Breakthrough Collaborative indicates
that a long-term goal of 2.75 vs. the initial
goal of 3.0 is more realistic. Targets for FYs
2008 and 2009 are based on this assumption. |
(4) |
This
goal is based on the projections for the total
number of kidney and kidney/pancreas transplants
performed using deceased donor organs. This estimate
is related directly to performance measure 23.II,
A.5 (see note 1). The number of deceased donor
kidney and kidney/pancreas transplants is assumed
to be 50 percent of the annual total number of
deceased donor organs transplanted. Targets for
FYs 2008 and 2009 are based on this assumption.
|
(5) |
This
measure is implicit in the target for the number
of deceased donor organs transplanted. However,
since this measure is widely used by OPOs and
the Department in assessing donor hospital performance
and was a key measure used in the Organ Donation
Breakthrough Collaborative, it is being included
as a performance measure for purposes of transparency.
|
(6) |
The
initial measure was developed based on the assumption
that there were 12,000 eligible donors. Per note
(1) above, the estimate is closer to 11,000. This
measure assumes an increasing percentage of eligible
donors to actual donors over time until a 75 percent
conversion rate is achieved in 2013. The revised
annual increase is 234 instead of 333. Targets
for FYs 2008 and 2009 are based on this assumption. |
(7) |
This
measure was based on the assumption that the number
of cardiac-death donors would be increased by
175 each year. Analysis conducted in association
with the Organ Transplantation Breakthrough Collaborative
indicates that a long-term goal of 10 percent
cardiac death donors as a percentage of total
deceased donors is a more realistic target. The
revised annual increase is 0.57 percent. Targets
for FYs 2008 and 2009 are based on this assumption.
|
(8)
|
The
OPTN cost per deceased donor organ transplanted
is influenced by the number of deceased donor
organs transplanted and the total cost of OPTN
operations including both Federal and non-Federal
support. The FY 2008 and 2009 targets were adjusted
upward to reflect the revised target for the number
of deceased donor organs transplanted (see note
1). Additionally, the cost of OPTN operations
have increased to provide greater information
technology capability and expanded OPTN member
compliance review and oversight. |
(9) |
The current OPTN contract ends in FY 2011. |
|