UW Hospital and Clinics Organ Procurement Organization (OPO) Tony D’Alessandro, MD Medical Director, UWHC OPO November 4, 2009

What is an OPO? 58 Federally Designated Organ Procurement Organizations (OPOs) in the United States Must be nonprofit organizations-- In Wisconsin: UW Health Organ Procurement Organization (“OPO”) Wisconsin Donor Network (Milwaukee) Lifesource ( Minnesota) Regulated by the Centers for Medicare & Medicaid Services (CMS) and United Network for Organ Sharing (UNOS) Accredited by the Association of Organ Procurement Organizations (AOPO) Audited by the Food and Drug Administration (FDA), Tissue Banks (4) and Lions Eye Bank; Participate in The Joint Commission surveys There are 58 OPOs with 8 hospital-owned OPOs such as our’s, and 50 independently-owned OPOs. The Wisconsin Donor Network was previously owned by Froedtert, but is in the process of becoming an independent OPO, reducing the hospital-owned number to 7.

Role of an OPO Coordinate the organ donation process Donor management, organ allocation, transportation, surgical recovery team(s), etc. 86% of organs recovered transplanted at UWHC Hospital development Generate referrals from donor hospitals, educate and train healthcare professionals, monthly death chart reviews, etc. Public education on organ donation awareness Donor family follow-up and donor family/recipient correspondence Data reporting & regulatory compliance Coordinates services with tissue and eye banks The responsibilities of an OPO are identified by CMS and UNOS and include. . . Data reporting and regulatory compliance are mandatory and include requirements such as performing chart reviews in 20+ hospitals monthly throughout the region on all patient deaths.

Governing Body UWHC Authority Board is the governing body of the UWHC OPO with full legal authority & responsibility for management and provision of all OPO services: Appoints individual responsible for day-to-day operations Delegates authority to review performance, fiscal operations, oversee policies & procedures, and the Quality Assessment and Performance Plan

The UW OPO is located in Research Park and has more than 30 employees. UW Health OPO Donation Service Area UWHC OPO 105 hospitals 70 counties 3.2 million population The UW Health Donor Service Area (DSA) is designated by the federal government. This area is shown in red and the light blue. The light blue counties are shared counties with other OPOs. There are 105 hospitals in 70 counties that include 3.2 million people that UWHC is responsible for providing service to. The UW OPO is located in Research Park and has more than 30 employees.

Program Highlights Twelve Donor hospitals received the 2009 U.S. Dept. of Health & Human Services (HHS) Medal of Honor HHS Medal of Honor warded for a combination of achieving the national goals for conversion rate, yield and DCD donors. OPO received 2 awards this year for conversion rate and Donation after Cardiac Death (DCD) donors

Centers for Medicare/Medicaid (CMS) OPO Conditions of Participation Updated CMS regulations effective 7/30/06 include standards for: Certification and Designation Re-certification and De-certification Outcome Requirements Process Performance Measures 486.324 Condition: Administration and Governing Body Requires Advisory Board and Governing Body UWHC OPO must meet CMS Conditions of Participation to remain operational

Statistics Over 103,000 people waiting for a transplant in the U.S. Over 1,400 patients in Wisconsin One person added to the list every 17 min or 3,000 patients each month 18 people nationwide die every day waiting One donor can potentially donate up to 8 solid organs and help up to 40-50 people The main barrier to organ transplantation is organ availability which is why donor awareness education is so important. . . .

CMS Outcome Measurements Donation or Conversion Rate (eligible donors/eligible deaths) Cannot be 1.5 standard deviation below national mean (Next slide) Observed Rate Cannot be significantly lower than the Expected Rate (not yet available) Two out of the 3 below cannot be lower than one (1) standard deviation from national mean: Need to define donor types – SCD, ECD and DCD UW OPO* U.S. 3.66 3.64 2.45 1.81 .23 ? *CY2008 Number of organs transplanted per standard criteria donor Number of organs transplanted per expanded criteria donor Number of organs used for research per donor

Conversion Rates National Average 62% Conversion Rate: (Eligible Donors/Eligible Deaths) Adjusted Conversion Rate: (Eligible Donors + Other Donors/Eligible Deaths + Other Donors) National Average 62%

Deceased Donor Activity Record

UW Health OPO Donor Referrals Define Donor Referrals

Import & Export Organs Difference = 16 Difference = 18 Difference = 60 Define imports and exports; increased workload for these Difference = 78

2010 Upcoming Events First unannounced CMS survey Establishment of Wisconsin statewide donor registry Co-host of U.S. Transplant Games to be held in Madison on July 30-August 4, 2010