Comparing Deceased Organ Donation Performance in Two Countries that Use Different Metrics: Comparing Apples With Apples

Abstract

Organ donation networks audit and report on national or regional organ donation performance, however there are inconsistencies in the metrics and definitions used, rendering comparisons difficult or inappropriate. This is despite multiple attempts exploring the possibility for convergently evolving audits so that collectives of donation networks might transparently share data and practice and then target system interventions. This paper represents a collaboration between the United Kingdom and Australian organ donation organisations which aimed to understand the intricacies of our respective auditing systems, compare the metrics and definitions they employ and ultimately assess their level of comparability. This point of view outlines the historical context underlying the development of the auditing tools, demonstrates their differences to the Critical Pathway proposed as a common tool a decade ago and presents a side-by-side comparison of donation definitions, metrics and data for the 2019 calendar year. There were significant differences in donation definition terminology, metrics and overall structure of the audits. Fitting the audits to a tiered scaffold allowed for reasonable comparisons however this required substantial effort and understanding of nuance. Direct comparison of international and inter-regional donation performance is challenging and would benefit from consistent auditing processes across organisations.

Keywords: auditing; definitions; metrics; organ donation; performance; reporting; transplantation.

FIGURE 1

Structure of donation performance audits in the UK (left) and Australia (right). *Not publicly available, **refers to “Actual donors: DCD,” a small subset of those who are brain dead who enter a DCD pathway by specific request of family.