Faculty Bibliography

Despite countless media campaigns, organ donation rates in the United States have remained static while need has risen dramatically. New efforts to increase organ donation through public education are necessary to address the waiting list of over 100,000 patients. On May 1, 2012, the online social network, Facebook, altered its platform to allow members to specify "Organ Donor" as part of their profile. Upon such choice, members were offered a link to their state registry to complete an official designation, and their "friends" in the network were made aware of the new status as a donor. Educational links regarding donation were offered to those considering the new organ donor status. On the first day of the Facebook organ donor initiative, there were 13 054 new online registrations, representing a 21.1-fold increase over the baseline average of 616 registrations. This first-day effect ranged from 6.9x (Michigan) to 108.9x (Georgia). Registration rates remained elevated in the following 12 days. During the same time period, no increase was seen in registrations from the DMV. Novel applications of social media may prove effective in increasing organ donation rates and likewise might be utilized in other refractory public health problems in which communication and education are essential.

The recent CMS conditions of participation are based on risk-adjusted models produced by the Scientific Registry for Transplant Recipients (SRTR). The accuracy of these models in identifying poor-performing centers is unknown. In this stochastic simulation study, 1-year mortality outcomes were simulated in virtual transplant centers, and used to flag centers according to the methods used by CMS, evaluating nine overlapping 2.5-year periods of simulated data. In a simulation where all centers had the same underlying risk, 10.2% were falsely flagged at least once during the 4.5 years of simulated evaluations. The probability of false-positive flagging was lowest in low-volume centers (2.5%) and highest in high-volume centers (16.2%). In another simulation where 5% of centers were assigned twofold risk ("poor-performing centers"), only 32% of poor-performing centers were correctly flagged. In a final simulation where each center was assigned a unique mortality risk, 94% of flagged centers had greater-than-median risk, but only 32% of flagged centers were among the 5% with highest risk. Even after disregarding known covariate limitations to the risk adjustment models, statistical noise alone leads to spurious flagging of many adequately-performing transplant centers, yet the methods used by CMS fail to flag most centers with true elevated risk.