Contribution of donor hospital characteristics to deceased donor organ recovery rates.

The Centers for Medicare and Medicaid Services evaluates Organ Procurement Organizations (OPOs) based on donation and transplant rates within their donation service area, but individual hospital-level characteristics may also significantly impact organ recovery. We examined how hospital-level factors influence recovery rates using 2023 data from the Scientific Registry of Transplant Recipients database, the Centers for Medicare and Medicaid Services Hospital Provider Data, and Cost Reports. A hierarchical negative binomial model with OPO random intercepts was used to evaluate hospital-level organ recovery (organs recovered/total discharges). In 2023, OPOs recovered organs for transplant at 1,776 hospitals. Compared with private hospitals, recovery rates were higher in government-owned (incidence rate ratio [IRR], 1.24; 95% confidence interval [CI], 1.08-1.42) and nonprofit hospitals (IRR, 1.19; 95% CI, 1.05-1.35). Hospitals located in the most distressed areas (IRR, 1.18; 95% CI, 1.03-1.35), transplant centers (IRR, 1.19; 95% CI, 1.05-1.33), and trauma levels I (IRR, 2.21; 95% CI, 1.98-2.47) and II (IRR, 1.86; 95% CI, 1.69-2.05) centers had higher rates. Higher patient experience/trust scores were associated with lower recovery rates (IRR, 0.89; 95% CI, 0.85-0.93), whereas mortality/acuity was positively associated (IRR, 1.15; 95% CI, 1.10-1.21). Recovery rates were higher for hospitals linked to OPOs with transfer models (IRR, 1.37; 95% CI, 1.06-1.78) or freestanding donor care units (IRR, 1.17; 95% CI, 1.02-1.34). Interventions at specific donor hospitals may significantly improve organ recovery rates, and prospective OPO performance measures may need to account for hospital-level factors, recognizing their substantial influence on the organ donation process.