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SPH professor: Organ donation system needs better evaluation

More than 80,000 people are waiting for a life-saving organ transplant in the United States but many of their needs will never be met; 17 people die every day waiting for a transplant, according to the United Network for Organ Sharing.

Because of the tremendous unfilled need, a School of Public Health (SPH) faculty member believes the organ procurement system needs closer monitoring.

"The main thing we need to do to get more organs is to do a better job of identifying donors and getting their consent," says Richard Hirth, associate professor of health management and policy at SPH. Identifying donors and getting their consent are duties of federally designated organ procurement organizations, which Hirth helped examine for a paper that appears in the October issue of the journal Health Services Research.

The primary problem, as Hirth sees it: "The organizations responsible for organ procurement have escaped any meaningful performance evaluation."

In 1984, the National Organ Transplant Act set up a system of nonprofit organ procurement organizations, funded through cost-based reimbursement, with a geographic territory to serve without competition. These organizations are charged with educating the public about organ donation, providing clinical services to manage organ and tissue recovery, and working with donor families and hospital staff during the consent process.

Oversight is the responsibility of Centers for Medicare and Medicaid Services. Hirth's paper calls the oversight ineffective. He says the oversight body tallies organ donors per 1 million living residents in the geographic area the organization serveswithout consideration for the average age of local residents, their ethnicity, their religion or typical causes of death. All affect whether a dying person's family is likely to agree to donate usable organs.

For example, Blacks traditionally have been more reluctant to donate organs, so an organization in an area with a higher percentage of Black residents might not get as many donations. Similarly, the elderly are more likely to have chronic health problems that prevent them from donating healthy organs.

Hirth and his co-authors calculated the number of potential organ donors in 1993­94 as 98,628, and the actual number of donations as 9,830. They calculated donor rates for various groups, from a high of 48.5 percent of potential male donors 17 and younger, to a low of 1.1 percent of Black women ages 50­74. Their proposed model would use these different likelihoods of donation as part of the evaluation process. Their two-year study concluded 16 of the nation's 64 organ procurement organizations could be identified reliably as doing better than expected given the characteristics of their potential donors and 13 could reliably be identified as doing worse than expected.

"If we don't really know who's doing well, how can we learn from them and apply that knowledge to the poor performers?" Hirth says.

Hirth, also an associate professor of internal medicine, worked on the project with Sheryl Stogis, a recent graduate of the doctorate in public health program in the SPH Department of Health Management and Policy; Robert L. Strawderman, a former U-M professor who now is associate professor of biometrics at Cornell University; Jane Banaszak-Holl, assistant professor of health management and policy; and Dean Smith, professor of health management and policy. For more information on Hirth, visit http://www.sph.umich.edu/faculty/rhirth.html; on Health Services Research, visit http://www.hsr.org; on United Network for Organ Sharing, visit http://www.unos.org/frame_default.asp; and on the Association of Organ Procurement Organizations, visit http://www.aopo.org/aopo/.

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