TY - JOUR
T1 - Performance indicators for organ donation and transplantation programmes in Europe
T2 - modified Delphi consensus study
AU - Streit, Simon
AU - Wharton, George
AU - Mah, Jasmine
AU - van Kessel, Robin
AU - Prionas, Apostolos
AU - Johnston-Webber, Charlotte
AU - Boletis, John
AU - Domínguez-Gil, Beatriz
AU - Forsberg, Anna
AU - França, Ana
AU - Gardiner, Dale
AU - Jeurissen, Patrick
AU - Papanicolas, Irene
AU - Pearcey, Oliver
AU - Rasmussen, Allan
AU - Romagnoli, Jacopo
AU - Mossialos, Elias
AU - Papalois, Vassilios
N1 - © The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd.
PY - 2025/12/24
Y1 - 2025/12/24
N2 - BACKGROUND: Health system performance assessment helps identify areas for improvement and guides policy initiatives. Although well-validated indicators exist for measuring organ donation and transplantation performance at the facility level, consensus on indicators for assessing national programmes is lacking. The aim of this study was to develop a comprehensive scorecard for evaluating national organ donation and transplantation programmes.METHODS: A three-step approach was used. First, a targeted literature review identified potential indicators from regulatory documents, national transplant organization reports, and databases. Second, indicators were mapped to an established transplant system framework and refined through preliminary expert consultations. Third, a modified Delphi consensus process validated the indicators. The Delphi panel comprised international experts in health policy, organ donation, transplantation, and patient representation. Participants rated 168 indicators using a five-point Likert scale across two rounds (24 experts completed round 1 and 22 experts completed round 2). Consensus for inclusion required 80% agreement.RESULTS: Of 168 indicators evaluated, 103 achieved consensus for inclusion. After consolidation of organ-specific indicators, the final set contained 84 indicators across seven domains: monitoring and reporting (8 indicators), prevention and need (9 indicators), waiting lists (11 indicators), consent (4 indicators), donation (28 indicators), transplantation (14 indicators), and follow-up (10 indicators). The indicator set incorporates established metrics such as waiting list statistics, donation rates, and complication rates alongside novel system-level indicators addressing structural factors, patient-centredness, and equity in care delivery.CONCLUSION: This validated indicator set provides a standardized tool for assessing and comparing transplant system performance across European countries, supporting performance benchmarking and evidence-informed policy development.
AB - BACKGROUND: Health system performance assessment helps identify areas for improvement and guides policy initiatives. Although well-validated indicators exist for measuring organ donation and transplantation performance at the facility level, consensus on indicators for assessing national programmes is lacking. The aim of this study was to develop a comprehensive scorecard for evaluating national organ donation and transplantation programmes.METHODS: A three-step approach was used. First, a targeted literature review identified potential indicators from regulatory documents, national transplant organization reports, and databases. Second, indicators were mapped to an established transplant system framework and refined through preliminary expert consultations. Third, a modified Delphi consensus process validated the indicators. The Delphi panel comprised international experts in health policy, organ donation, transplantation, and patient representation. Participants rated 168 indicators using a five-point Likert scale across two rounds (24 experts completed round 1 and 22 experts completed round 2). Consensus for inclusion required 80% agreement.RESULTS: Of 168 indicators evaluated, 103 achieved consensus for inclusion. After consolidation of organ-specific indicators, the final set contained 84 indicators across seven domains: monitoring and reporting (8 indicators), prevention and need (9 indicators), waiting lists (11 indicators), consent (4 indicators), donation (28 indicators), transplantation (14 indicators), and follow-up (10 indicators). The indicator set incorporates established metrics such as waiting list statistics, donation rates, and complication rates alongside novel system-level indicators addressing structural factors, patient-centredness, and equity in care delivery.CONCLUSION: This validated indicator set provides a standardized tool for assessing and comparing transplant system performance across European countries, supporting performance benchmarking and evidence-informed policy development.
KW - Humans
KW - Delphi Technique
KW - Europe
KW - Tissue and Organ Procurement/standards
KW - Quality Indicators, Health Care
KW - Organ Transplantation/standards
KW - Consensus
KW - Health Policy
U2 - 10.1093/bjs/znaf293
DO - 10.1093/bjs/znaf293
M3 - Journal article
C2 - 41569582
SN - 0007-1323
VL - 113
JO - The British journal of surgery
JF - The British journal of surgery
IS - 1
ER -