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J D Rosendale

Publications and source records attributed to J D Rosendale.

12 recordsLinked to original sources
PubMed2006

SRTR center-specific reporting tools: Posttransplant outcomes.

Measuring and monitoring performance--be it waiting list and posttransplant outcomes by a transplant center, or organ donation success by an organ procurement organization and its partnering hospitals--is an important component of ensuring good care for people with end-stage organ failure. Many parties have an interest in examining these outcomes, from patients and their families to payers such as insurance companies or the Centers for Medicare and Medicaid Services; from primary caregivers providing patient counseling to government agencies charged with protecting patients. The Scientific Registry of Transplant Recipients produces regular, public reports on the performance of transplant centers and organ procurement organizations. This article explains the statistical tools used to prepare these reports, with a focus on graft survival and patient survival rates of transplant centers--especially the methods used to fairly and usefully compare outcomes of centers that serve different populations. The article concludes with a practical application of these statistics--their use in screening transplant center performance to identify centers that may need remedial action by the OPTN/UNOS Membership and Professional Standards Committee.

Adolescent↗
PubMed2001

Organ procurement organization (OPO), best practices.

There are currently 59 organ procurement organizations (OPOs) in the United States which serve their assigned geographic areas with variable productivity. Knowledge of organizational characteristics, programs and practices of more successful OPOs may be useful to increase the productivity of less successful OPOs. A preliminary survey of all OPO executive directors in the United States ascertained the most important beneficial and detrimental factors affecting their success. Site visits were then conducted at OPOs based on a selection process utilizing population size, geographic location, minority population, donors per million population and donors per thousand deaths among potential donors. All OPOs were categorized and the highest ranking OPOs in each of seven categories, based on 4 years of national data, were selected for the site visits. Regression analysis and correlation analysis using Pearson's product-moment correlation were performed. The survey to identify the important factors was returned by 47 (77%) of 61 OPOs existent in 1999. The most important beneficial factors identified by responding OPOs were adequate staffing and experience, allocation of responsibilities, hospital development and leadership. The most important detrimental factors were inadequate staffing and experience, poor donor hospital/transplant center/ OPO relationships and failure in the consent process. Site visits of the highest-ranking OPOs demonstrated all had respected, experienced leadership focused on the donation process; efficient mechanisms for resolving allocation or transplant center conflicts; systems for monitoring activity and tracking outcomes; excellent communication between OPO and transplant centers; open internal communication at all levels of the OPO; immediate, on-site response to vascular donor referrals; and volunteer support of public and/or professional education. Regression and correlation analysis demonstrated that as minority population increases, OPO performance declines (P < 0.03). Moreover, independent OPOs were associated with poorer performance regardless of minority population (P < 0.05). All of the successful OPOs visited had strong leadership, excellent donor hospital and transplant center relationships, well-developed communication and innovative methods to deal with their minority populations. Application of these practices within all OPOs could significantly enhance organ donation.

Humans↗
PubMed2001

Organ donation in the United States: 1988-2000.

Based upon information reported to the United Network for Organ Sharing: 1. There were 5,985 cadaveric and 5,702 living donors recovered in 2000, a 47% and 213% increase, respectively, over those recovered in 1988. 2. The number of cadaveric donors aged 50 or older has increased from 12% of all donors in 1988 to 31% of all donors in 2000. 3. The typical cadaveric donor in 2000 was a white male with ABO blood type O between the ages of 18-34. In 2000, a typical living donor was a white female with ABO blood type O between the ages of 35-49. 4. Between 1988-2000, the percentage of minority donors increased for cadaveric donors (17% to 26%), and for living donors (24% to 31%). 5. The number of living donors who were either spouses or unrelated to the recipient increased from 4% in 1988 to 26% in 2000. 6. In 2000, California (9.6%) was most often listed as the state of residence for cadaveric donors, followed by Texas (7.7%) and Florida (7.3%). 7. In 2000, cadaveric donors were recovered most often on Tuesdays (15.0%), followed by Thursdays (14.8%) and Fridays (14.7%). 8. In 2000, living donors were recovered most often on Wednesdays (27.8%), followed by Tuesdays (26.7%) and Thursdays (19.9%). 9. In 2000, cadaveric donors were recovered most often in July (9.2%), followed by September (9.0%), January and April (8.7%). 10. In 2000, living donors were recovered most often in June (9.5%), followed by November (9.2%) and August (9.0%).

Adolescent↗
PubMed1999

Organ donation in the United States: 1990-1998.

1. There were 5,799 cadaver and 4,274 living donors recovered in 1998, 29% and 101% increases, respectively, over those recovered in 1990. 2. The number of cadaver donors aged 50 or older has increased from 16% of all donors in 1990 to 29% of all donors in 1998. 3. The typical cadaver donor in 1998 was a White male with ABO blood type O between the ages of 18-34. In 1998, a typical living donor was a White female with ABO blood type O between the ages of 35-49. 4. Between 1990 and 1998, the percentage of minority donors increased for cadaver donors (18% to 24%), and for living donors (24% to 27%). 5. The number of living donors who were either spouses or unrelated to the recipient increased from 5% in 1990 to 18% in 1998. 6. California (10.2%) was most often listed as the state of residence for cadaver donors, followed by Texas (7.3%) and Florida (7.0%). 7. Cadaver donors are recovered most often on Tuesdays (15.2%), followed by Wednesdays (14.6%) and Fridays (14.3%). 8. Living donors are recovered most often on Wednesdays (32.4%), followed by Tuesdays (27.5%) and Thursdays (21.3%). 9. Cadaver donors are recovered most often in August and May (8.8%), followed by July and October (8.7%). 10. Living donors are recovered most often in June (10.5%), followed by July (10.0%) and August (8.3%). 11. In 1998, there were 21.4 donors recovered per million population in the United States.

ABO Blood-Group System↗
PubMed1998

Center-specific graft and patient survival rates: 1997 United Network for Organ Sharing (UNOS) report.

CONTEXT: Multiple comprehensive, risk-adjusted studies evaluating short-term surgical mortality have been reported previously. This report analyzes short-term and long-term outcomes, both nationally and at each individual transplant program, for all solid organ transplantations performed in the United States. OBJECTIVES: To report graft and patient survival rates for all solid organ transplantations, both nationally and at each specific transplant program in the United States, and to compare the expected survival rate with the actual survival rate of each individual program. DESIGN AND SETTING: Multivariate regression analysis of donor and recipient factors affecting graft and patient survival of all kidney, liver, pancreas, heart, lung, and heart-lung transplants reported to the United Network for Organ Sharing from 742 separate transplant programs. PATIENTS: A cohort of 97587 solid organ transplantations performed on 92966 recipients in the United States from January 1988 through April 1994. MAIN OUTCOME MEASURES: Short-term and conditional 3-year national and individual transplant program graft and patient survival rates overall and from 2 separate eras (era 1, January 1988-April 1992; era 2, May 1992-April 1994); comparison of actual center-specific performance with risk-adjusted expected performance and identification of centers with better-than-expected or worse-than-expected survival rates. RESULTS: One-year graft follow-up exceeded 98% and conditional 3-year follow-up exceeded 91% for all organs. Graft and patient survival improved significantly in era 2 compared with era 1 for all cadaver organs except heart, which remained the same. One-year cadaveric graft survival ranged from 81.5% for heart to 61.9% for heart-lung and 3-year conditional graft survival ranged from 91.3% for pancreas to 74.7% for lung. The percentage of programs whose actual 1-year graft survival was not different from or was better than their risk-adjusted expected survival ranged from 98.3% for heart-lung to 75.7% for liver. Most kidney, liver, and heart programs whose actual survival was significantly less than expected performed small numbers (less than the national average) of transplantations per year. CONCLUSIONS: Graft and patient survival for solid organ transplantations showed improvement over time. Conditional 3-year graft and patient survival rates were approximately 90% for all organs except for lung and heart-lung. The conditional 3-year survival rates were better than 1-year survival rates, indicating the major risk after transplantation occurs in the first year. The majority of transplant programs achieved actual survival rates not significantly different from their expected survival rates. Center effects were most significant within the first year after transplantation and had much less influence on long-term survival outcomes.

Actuarial Analysis↗
PubMed1998

The UNOS OPTN waiting list and donor registry.

1. On October 31, 1998, there were 62,994 registrants on the combined UNOS waiting list. Of these, 66% were awaiting kidney transplantation, and 18% were awaiting liver transplantation. 2. The majority of patients on the UNOS waiting list on October 31, 1998 were blood type O (52%), White (60%) and male (58%). 3. Median waiting times (MWTs) have increased steadily for nearly every organ since 1988, especially for liver, kidney, and lung registrants. 4. For patients added to the waiting list in 1996. MWTs to transplant were longest for heart-lung registrants (742 days). The shortest waiting times for this cohort were among heart registrants (223 days). No median could be calculated for kidney registrants added in 1996. 5. Death rates per patients waiting at risk declined during 1988-1997. Death rates were higher for patients awaiting life-saving organs (liver, heart, lung, heart-lung) than for non-lifesaving organs (kidney, pancreas, kidney-pancreas). 6. There were 5,478 cadaveric and 3,820 living donors recovered in 1997, a 34% and 109% increase over those recovered in 1988. 7. Large increases were seen in the number of liver (45-84%), pancreas (14-24%), and lung (3-15%) donors between 1988-1997. 8. The number of cadaveric donors aged 50 or older has increased from 12% of all donors in 1988 to 28% of all donors in 1997. 9. The typical cadaveric donor in 1997 was a white male with ABO blood type O, between the ages of 18-34. In 1997, a typical living donor was a white female with ABO blood type O between the ages of 35-49. 10. Between 1988-1997, the percentage of minority donation increased for cadaveric donors (17-24%), and for living donors (23-27%). 11. The number of living donors who were either spouses or unrelated to the recipient increased from 4% in 1988 to 15% in 1997.

ABO Blood-Group System↗
PubMed1997

National impact of pulsatile perfusion on cadaveric kidney transplantation.

BACKGROUND: The simplicity and success of cold storage of cadaveric kidneys have led to the infrequent use of pulsatile perfusion. However, there may be advantages to pulsatile perfusion for less optimal donors. METHODS: United Network for Organ Sharing data were analyzed retrospectively to determine the impact of pulsatile perfusion on initial function and 1-year graft survival. The analysis included 60,827 cadaveric kidney transplants performed between 1988 and 1995. Multivariate logistic regression analyses were used to determine the effect of preservation method on both early kidney function (need for first-week dialysis after transplant) and 1-year graft survival, after adjusting for other known risk factors. RESULTS: The preservation method exhibited a highly significant impact on the need for first-week dialysis. Ice-preserved kidneys were associated with a 2.13-fold increase in the odds of requiring dialysis compared with perfused kidneys. If the donor age was > or =55 years, the odds were 2.33-fold higher for ice-preserved as compared with perfused. If cold ischemic time was > or =24 hr, there was a 2.19-fold increase in the odds of dialysis for ice-preserved kidneys. African-American recipients of cold-stored kidneys had a 2.29-fold greater odds of first-week dialysis. CONCLUSIONS: Based on these findings, it was estimated that the increased cost of perfusing kidneys from all donors > or =55 years of age would be balanced by the decreased need for posttransplant dialysis if the cost related to dialysis were $14,700 or greater per patient. These facts, coupled with the ability to assess an older donor kidney before transplant, could make pulsatile perfusion for the expanded donor financially as well as medically desirable.

Adult↗
PubMed1997

The UNOS OPTN waiting list and donor registry.

1. On October 31, 1997, there were 55,789 registrations on the combined UNOS waiting list. Of these, two-thirds were awaiting kidney transplantation, and 17% were awaiting liver transplantation. 2. More than one-half of all patients on the UNOS waiting list on October 31, 1997 had blood type O, 59% were White, 58% were male, and 54% were aged 18-49. 3. Annual additions to the UNOS kidney waiting list grew from 11,916 in 1988 to 18,253 in 1996. The largest increase in waiting list size was seen in the lung waiting list, which grew 1,482% during this time. 4. Median waiting times have increased steadily for nearly every organ since 1988, especially for liver, kidney, and lung registrants. 5. For patients added to the waiting list in 1995, MWTs to transplant were longest for heart-lung registrants (887 days); however, no median could be calculated for kidney registrants added in 1995. The shortest waiting times for this cohort were experienced by heart registrants (208 days). 6. Death rates per 1,000 patient-years at risk have declined during 1988-1996. Death rates were higher for patients awaiting life-saving organs (liver, heart, lung, heart-lung) than for non-lifesaving organs (kidney, pancreas, kidney-pancreas). 7. There were 5,417 cadaveric and 3,553 living donors recovered in 1996, a 33% and 95% increase, respectively, over those recovered in 1988. 8. The number of organs recovered per cadaveric donor increased from 3.0 in 1988 to 3.8 in 1994 and dropped to 3.6 in 1996. At the same time, the number of organs transplanted per cadaveric donor recovered increased from 2.7 to 3.2. 9. Large increases in the number of donors who were liver (45-82%), pancreas (14-23%), and lung (3-14%) donors occurred between 1988 and 1996. 10. The number of cadaveric donors aged 50 or older has increased from 12% of all donors in 1988 to 27% of all donors in 1996. 11. The typical cadaveric donor in 1996 was a White male with ABO blood type O, between the ages of 18-34. In 1996, a typical living donor was a White female with ABO blood type O between the ages of 35-49. 12. Between 1988 and 1996, the percentage of minority donations increased for cadaveric donors (17-23%), and for living donors (24-27%). 13. The number of living donors who were either spouses or unrelated to the recipient increased from 4% in 1988 to 14% in 1996.

ABO Blood-Group System↗
PubMed1996

The UNOS OPTN Waiting List and Donor Registry: 1988-1996.

1. There were 49,233 registrations on the combined UNOS waiting list as of October 31, 1996, an increase of 207% over December 31, 1988. Of these, 69% were awaiting kidney transplantation, and 14.6% were awaiting liver transplantation. 2. More than one-half of all patients on the UNOS waiting list on October 31, 1996 were blood type O, 60% were White, 58% were male, and 56% were aged 18-49. 3. Annual additions to the UNOS kidney waiting list grew from 11,909 in 1988 to 17,635 in 1995. The largest increase in waiting list size was in the lung waiting list, which grew from 126 additions in 1988 to 1,706 additions in 1995. 4. For patients registering in 1994, median waiting times to transplant were longest for kidney registrants (842 days), followed by heart-lung registrants (612 days). The shortest waiting times for this cohort were experienced by liver registrants (173 days). 5. In general, death rates per 1,000 patient years at risk have declined during 1988-1995. Death rates were higher for patients awaiting life-saving organs (liver, heart, lung, heart-lung) than for non-lifesaving organs (kidney, pancreas, kidney-pancreas). 6. There were 5,359 cadaveric and 3,215 living donors recovered in 1995, a 31% and 76% increase, respectively, over the numbers recovered in 1988. 7. The number of organs recovered per cadaveric donor increased from 2.98 in 1988 to 3.68 in 1995. At the same time, the number of organs transplanted per cadaveric donor recovered increased from 2.73 to 3.24. 8. Large increases were seen in the number of recovered donors who were liver (45-81%), pancreas (14-24%), and lung (3-17%) donors between 1988-1995. 9. The number of cadaveric donors aged 50 or older has increased 172% from 1988 (475 donors) to 1995 (1,292 donors). 10. The typical cadaveric donor in 1995 was a White male with blood type O, between the ages 18-34. In 1995, a typical living donor was a White female with blood type O, aged 35-49. 11. Between 1988-1995, the percentage of minority donation has increased for cadaveric donors (16.4-22.8%), and for living donors (24.0-27.5%). 12. The number of spouses or other unrelated living donors has increased from 4% in 1988 to 11% in 1995.

Adolescent↗