Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;18(9):2182-2188.
doi: 10.1111/ajt.14907. Epub 2018 Jun 4.

Kidney offer acceptance at programs undergoing a Systems Improvement Agreement

Mary G Bowring  1 , Allan B Massie  1   2 , Rebecca Craig-Schapiro  3 , Dorry L Segev  1   2   4 , Lauren Hersch Nicholas  1   5
Affiliations

Kidney offer acceptance at programs undergoing a Systems Improvement Agreement

Mary G Bowring et al. Am J Transplant. 2018 Sep.

Abstract

In the United States, the Centers for Medicare and Medicaid Services (CMS) use Systems Improvement Agreements (SIAs) to require transplant programs repeatedly flagged for poor-performance to improve performance or lose CMS funding for transplants. We identified 14 kidney transplant (KT) programs with SIAs and 28 KT programs without SIAs matched on waitlist volume and characterized kidney acceptance using SRTR data from 12/2006-3/2015. We used difference-in-differences linear regression models to identify changes in acceptance associated with an SIA independent of program variation and trends prior to the SIA. SIA programs accepted 26.9% and 22.1% of offers pre- and post-SIA, while non-SIA programs accepted 33.9% and 44.4% of offers in matched time periods. After adjustment for donor characteristics, time-varying waitlist volume, and secular trends, SIAs were associated with a 5.9 percentage-point (22%) decrease in kidney acceptance (95% CI: -10.9 to -0.8, P = .03). The decrease in acceptance post-SIA was more pronounced for KDPI 0-40 kidneys (12.3 percentage-point decrease, P = .007); reductions in acceptance of higher KDPI kidneys occurred pre-SIA. Programs undergoing SIAs substantially reduced acceptance of kidney offers for waitlisted candidates. Attempts to improve posttransplant outcomes might have the unintended consequence of reducing access to transplantation as programs adopt more restrictive organ selection practices.

Keywords: Organ Procurement and Transplantation Network (OPTN); Scientific Registry for Transplant Recipients (SRTR); clinical decision-making; clinical research/practice; ethics and public policy; kidney transplantation/nephrology; organ acceptance; organ procurement and allocation.

PubMed Disclaimer

Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
(A) Waitlist volume, (B) Probability of offer acceptance, and (C) Monthly deceased-donor kidney transplant volume among SIA and matched non-SIA programs in the two years pre- and post-SIA. Non-SIA and SIA programs matched 2:1 on waitlist volume two-years prior to the SIA.
Figure 2
Figure 2
Kidney offer acceptance among SIA and non-SIA programs in the two years pre- and post-SIA stratified by KDPI of the kidney offer Non-SIA and SIA programs were matched 2:1 on waitlist volume two-years prior to the SIA.
See this image and copyright information in PMC

Comment in

References

    1. Centers for M, Medicaid Services HHS. Medicare program; hospital conditions of participation: requirements for approval and re-approval of transplant centers to perform organ transplants. Final rule. Fed Regist. 2007 Mar 30;72(61):15197–280. - PubMed
    1. Schold JD, Buccini LD, Poggio ED, Flechner SM, Goldfarb DA. Association of Candidate Removals From the Kidney Transplant Waiting List and Center Performance Oversight. Am J Transplant. 2016 Apr;16(4):1276–84. - PubMed
    1. White SL, Zinsser DM, Paul M, Levine GN, Shearon T, Ashby VB, et al. Patient selection and volume in the era surrounding implementation of Medicare conditions of participation for transplant programs. Health Serv Res. 2015 Apr;50(2):330–50. - PMC - PubMed
    1. Schold JD, Buccini LD, Srinivas TR, Srinivas RT, Poggio ED, Flechner SM, et al. The association of center performance evaluations and kidney transplant volume in the United States. Am J Transplant. 2013 Jan;13(1):67–75. - PubMed
    1. Heilman RL, Green EP, Reddy KS, Moss A, Kaplan B. Potential Impact of Risk and Loss Aversion on the Process of Accepting Kidneys for Transplantation. Transplantation. 2017 Jul;101(7):1514–7. - PubMed

Publication types

MeSH terms

LinkOut - more resources