Evaluating Spatial Associations in Inpatient Deaths Between Organ Procurement Organizations.

Abstract

To account for the geographic variation in OPO performance and organ availability across the United States, we utilized spatial analysis to appraise the newly proposed metric of inpatient deaths. Using spatial clustering that accounts for geographic relationships between Organ Procurement Organizations, the top 5 causes of donation-eligible death, and inpatient deaths, we identified 4 unique OPO clusters. Each group had a distinct demographic composition, cause of death, and inpatient death pattern. In multivariate analysis accounting for these geographic relationships, the spatial clusters remained significantly associated with the outcome of inpatient deaths (P < 0.001) and were the best-fitting model compared with models without the spatial clusters; this suggests that further risk adjustment of inpatient deaths should include these geographic considerations. This approach provides not only a manner to assess donor potential by improving risk adjustment but also an opportunity to further explore geographic and spatial relationships in the practice of organ transplantation and OPO performance.