For the reports released in January 2021, all risk-adjusted transplant performance metrics (transplant rate, waitlist mortality rate, offer acceptance rate, overall mortality following listing, posttransplant outcomes) did not include data after March 12, 2020, the day prior to the declaration of a national public health emergency on March 13, 2020. Follow-up for all risk-adjusted outcomes of waitlist candidates and transplant recipients was stopped (i.e., statistically censored) on March 12, 2020.
For the reports released in January 2021, all risk-adjusted OPO performance metrics (eligible death donation rate, deceased donor organ yield) did not include donors after March 12, 2020, the day prior to the declaration of a national public health emergency on March 13, 2020.
Risk-adjusted transplant program performance metrics will be altered in the following ways:
Waitlist Mortality Rate:
Kidney and Lung Candidates: Candidates on the waitlist 1/1/2019-3/12/2020 will be evaluated.
Liver, Heart, Pancreas, and Intestine Candidates: Candidates on the waitlist 1/1/2019-12/31/2020 will be evaluated
The first quarter following declaration of a national emergency will be carved out of the transplant rate evaluations for all organ types. Candidates on the waitlist 1/1/2019-3/12/2020 and 6/13/2020-12/31/2020 will be evaluated. Waitlist time between March 13, 2020 and June 12, 2020 will not be evaluated.
Offer Acceptance Rate:
These evaluations will return to normal reporting cohorts. Offers received 1/1/2020-12/31/2020 will be evaluated.
Overall Mortality Following Listing:
Patient follow-up will continue to be truncated on 3/12/2020. The evaluation period will be: 1/1/2019-3/12/2020.
1-month and 1-year Posttransplant Graft and Patient Survival:
Evaluations cohorts will continue to exclude transplants and follow-up time beyond March 12, 2020. Transplants performed 1/1/2018-3/12/2020 will be evaluated with follow-up only evaluated through 3/12/2020.
3-year Patient and Graft Survival:
Evaluations cohorts will continue to exclude transplants and follow-up time beyond March 12, 2020. Transplants performed 1/1/2015-12/31/2017 will be evaluated with follow-up only evaluated through 3/12/2020.
Risk-adjusted OPO performance metrics will be altered in the following ways:
Eligible Death Conversion Rate:
Eligible deaths during the first quarter of the national emergency will be excluded from evaluation. Eligible deaths 1/1/2020-3/12/2020 and 6/13/2020-12/31/2020 will be evaluated.
Deceased Donor Organ Yield:
Deceased donors during the first quarter of the national emergency will be excluded from evaluation. Deceased donors 1/1/2019-3/12/2020 and 6/13/2020-12/31/2020 will be evaluated.
The SRTR Review Committee (SRC) reviewed data about the potential impact of the pandemic on the performance metrics at their meetings on July 7, 2020, September 2, 2020, January 20, 2021, and February 9, 2021, making recommendations to the SRTR and HRSA. HRSA subsequently approved the SRC’s recommendations.
The COVID-19 pandemic impacted the nation’s transplant system and healthcare system more broadly in ways that were unprecedented. The SRTR maintains a public web-based application detailing the impact of the pandemic on various aspects of transplantation. The committee’s primary concern was whether the performance metrics published by the SRTR could be systematically biased as a result of the pandemic, given the pandemic affected portions of the country differently at different times. The committee reviewed trends in performance metrics by month leading up to and following the declaration of a national public health emergency as well as assessments of geographic variability in the effect of the pandemic during the window of time being evaluated by each performance metric. For the January 2021 reports, the committee felt there was not yet enough information to conclude the risk of bias would be minimal, and therefore made the recommendation to censor all performance metrics for transplant programs and OPOs at the start of the national emergency. The committee reviewed updated data in January and February of 2021 and concluded some metrics could resume full reporting, some should eliminate the early period of the pandemic, and some should continue to truncated on March 12, 2020 as detailed above. Recommendations to resume reporting, where made, were made after concluding that the risk of bias due to differential effects of the pandemic based on geography or time were minimal.
Modifications to the reports were only made for risk-adjusted performance metrics. There are many areas of the report that simply report on the state of transplantation with unadjusted data. Because it continues to be valuable to report on the state of transplantation, reporting of unadjusted trends and counts continued. The risk-adjusted performance metrics, because they are designed to compare how a program or OPO is doing relative to expectation, were altered in response to the pandemic.
Yes. The SRTR Review Committee (SRC) will continue to evaluate the data and make recommendations to the SRTR and HRSA about how the performance metrics will be handled beyond the July 2021 reports.
Please email us at SRTR@SRTR.org.