Increasing Organ Donation and Transplantation: The Challenge of Evaluation. III. Performance Indicators


Performance indicators shape an evaluation, and the choice of performance indicators impacts the resources required to conduct the study and the utility of the study results. For example, measuring changes in public awareness of organ donation activities may not ultimately provide insight on what impact the study activity had on donation rates. Because it is impossible to predict who might become a potential organ donor before the occurrence of a traumatic event, any activity targeted at the general public must cast a wide net in order to reach those few people who will become potential organ donors. The complexity of an evaluation increases because there are a wide variety of reasons that potential donors do not become actual donors. These include not being identified as potential donors, caregivers not asking the families for permission to retrieve organs, families denying consent, and organs incorrectly deemed not transplantable (Gortmaker 1996). It is difficult to measure, with any statistical significance, the effect of a population-based program on the actual number of organs retrieved. The evaluation of population-based programs requires a careful selection of performance indicators based on the goals and resources of the organization conducting the evaluation.

To overcome limitations in measuring program effectiveness on actual organ retrieval, the organ donation community has used three related sets of performance indicators, each with varying

Exhibit 3: Sample Performance Indicators and Proximity to Donation


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Source: Lewin, 1998

degrees of separation from the actual intended outcome of organ donation. The three types of measures are shown in Exhibit 3 as concentric circles, illustrating their relative proximity to the donation event. In addition, the US population is used as an example to depict the relative sizes of the populations captured in pre-event, post-event, and donation measures.

  • Pre-event measures (represented by the outermost circle) are used to gauge effectiveness in increasing organ donation before an actual donation opportunity arises. The particular measures tend to be specific to the type of activity being performed. Compared to the other types of performance indicators, pre-event measures are most varied in nature, and are the farthest removed from the goal of measuring increased organ donation.
  • Post-event measures (the middle circle) are commonly used in the organ donation community to measure the five crucial steps in organ retrieval after a potential donor situation has occurred. Chronologically, and with increasingly close ties to donation itself, these steps measure: 1) donor identification rate, 2) referral rate, 3) request rate, 4) consent rate, and 5) retrieval rate.
  • Donation rates (the innermost circle) represent the most direct measure of the success of programs to increase the number of organs made available for donation.