Quality metrics in solid organ donation: A narrative review

Table 1 Evidence on quality metrics in organ donation - United States

Ref.	Year	Country	Main results	Limitations/characteritics
Niroomand et al[4]	2020	United States	(2011-2014) an OPO’s ranking relative to other OPOs was static. Leadership changes increase the odd of rapid improvement	Study limitations: Changes in other executive team members were not assessed. OPO-level data on change in practice were not available
DeRoos et al[5]	2020	United States	The performance of OPOs was positively associated with the use of donors who were ineligible, which varied among OPOs and demographic subgroups	Quality indicator limitation (in put data). Donor ineligibility is dependent on OPOs. Therefore the analysis is restricted to OPO level
Goldberg et al[7]	2020	United States	43 states (48 OPOs) had data from 2012 to 2014 available for analysis: The CMS metric and the ventilation-adjusted CMS metric were highly concordant in absolute terms	Methodological investigation: Comparison between indicators
Doby et al[6]	2021	United States	CALC methods: Donor increased by 44%, organs transplanted rose by 29%	Quality indicator limitation: CALC datasets are based on death certificate data. No information on suitability
Lopez et al[9]	2023	United States	Cross sectional study: 58 OPOs (2028-2020). Adjusting for area deprivation and age significantly changed OPO measured performance and tier classifications	Quality indicator limitation (dependance of input data). Discrepancies in performance among areas

OPO: Organ procurement organization; CALC: Cause, age and location consistent; CMS: Centers for Medicare & Medicaid Services.

Table 2 Evidence on quality metrics in organ donation - Europe

Ref.	Year	Country	Main results	Limitations/characteritics
Manyalich et al[11]	2013	Consortium: Austria, Croatia, France, Germany, Italy, Poland, Portugal, Romania, Spain, Sweden, and the United Kingdom, as well as five collaborating partners from Greece, Hungary, Malta, Slovenia, and Turkey	131 quality criteria and 31 quality indicators	Methodological issues
Karpeta et al[19]	2024	Warsaw (Poland)	Hospitals with implementing procedures had significantly higher values than hospitals without	Critical analysis of quality assessment in donation activity
Lazzeri et al[25]	2025	Tuscany Region (Italy)	From January to November 2024, 352 donors (2024 January-November): Donation activity comparable 2024 vs in 2023 (101.2 vs 103 pmp). Controlled DCD increased (+13). Transplant activity: Increased (2024: 91.3 pmp vs 2023: 80 pmp)	A method for buidling a quality assessment system. This reporting system was suited to the Tuscany Region. However, the methodology of implementing this system may be trasferred to other donation and transplantation systems

pmp: Per milion population; DCD: Donation after circulatory death.