Rejecting bias: The case against race adjustment for OPO performance in communities of color. Issue 9 (9th April 2020)

• Record Type: Journal Article
• Authors: Goldberg, David; Doby, Brianna; Siminoff, Laura; Shah, Malay; Lynch, Raymond
• Is Part Of: American journal of transplantation. Volume 20:Issue 9(2020)
• Page Start: 2337
• Page End: 2342
• Publication Date: 2020-04-09
• Subjects: donors and donation -- editorial/personal viewpoint -- ethnicity/race -- organ procurement and allocation -- social sciences; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15865
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : In December of 2019, the Centers for Medicare and Medicaid Services (CMS) put out a notice of proposed rule‐making for 42 CFR Part 486, specifically the section that covers the organ procurement organization (OPO) Conditions for Coverage. Most crucially, the proposed rule included two new OPO performance metrics using objective, standardized data from the Centers for Disease Control and Prevention (CDC). These new metrics would employ a denominator that included inpatient deaths from certain causes that could lead to organ donation, rather than the current unverifiable eligible death metric. Although there has been near‐uniform support for replacing the eligible death denominator with CDC data, a source of contention is CMS's proposal not to adjust risk for race in their OPO outcome. Nonetheless, there have been calls for race and ethnicity to be included as risk‐adjusted variables in the CMS donation metric. Herein, we lay out an argument as to why inclusion of race and ethnicity as risk adjustment variables in an OPO performance metric is not only statistically suspect but also will hide the inequities that are detrimental to optimal system performance and assurance that all patients have timely access to donation. Abstract : The authors lay out an argument as to why inclusion of race and ethnicity as risk adjustment variables in an OPO performance metric is empirically unfounded and hides inequities that are detrimental to optimal system performance and to confidence that all patients have timely access to donation.