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Organ Quality Varies According to Transplant Center

Liver transplant centers with higher volume, local competition more likely to use low-quality organs

MONDAY, May 16 (HealthDay News) -- The quality of deceased-donor organs available for transplantation varies based on characteristics of the transplant center, according to a study published in the May issue of the American Journal of Transplantation.

Michael L. Volk, M.D., from the University of Michigan in Ann Arbor, and colleagues evaluated whether the quality of donor livers used in transplants varies between transplant centers, and whether some centers systematically use lower-quality organs. A total of 23,810 adults who underwent deceased-donor liver transplantation between January 2005 and February 2009 were included in the analysis. Variations in the donor risk index (DRI) were measured by region, organ procurement organization (OPO), and transplant center.

The investigators found that the mean DRI for transplant centers ranged from 1.24 to 1.74, even after adjusting for geographic region and OPO. Centers with higher volume, and those with competing centers within their OPO, were more likely to use organs with high risk, particularly for recipients with lower model for end-stage liver disease scores. Waiting-list mortality rates were similar in centers that use high-risk organs, but they tended to have an increased post-transplant mortality (hazard ratio, 1.10 for a mean DRI increase of 0.1).

"These findings provide further evidence that decision making about organ quality is influenced by external forces, and emphasizes the importance of transparency in organ acceptance practices," the authors write.

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