# Performance indicators for organ donation and transplantation programmes in Europe: modified Delphi consensus study

## TL;DR

This study created a standardized scorecard with 84 indicators to evaluate and compare organ donation and transplantation systems across European countries.

## Contribution

The study introduces a validated set of 84 performance indicators for national organ donation and transplantation programs, including novel metrics on equity and patient-centered care.

## Key findings

- A modified Delphi process with 30 international experts validated 84 indicators across seven domains.
- The indicators include both established metrics and novel system-level factors like equity and patient-centeredness.
- The scorecard enables standardized benchmarking and evidence-informed policy development across European countries.

## Abstract

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.

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.

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.

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.

This study developed a comprehensive scorecard of 84 validated performance indicators across seven domains to evaluate national organ donation and transplantation programmes. Using a modified Delphi consensus process with 30 international experts, researchers identified indicators that address both established metrics (such as donation rates and waiting list statistics) and novel system-level factors, including equity and patient-centredness. The validated indicator set provides a standardized tool for benchmarking transplant system performance across European countries and supporting evidence-informed policy development.