Scientific Registry of Transplant Recipients (SRTR)

The Scientific Registry of Transplant Recipients (SRTR) is a national database and analytic program that supports the evaluation of solid-organ transplantation in the United States, including the performance of individual transplant programs and organ procurement organizations.[1][2] The SRTR operates under contract to, and oversight by, the Health Resources and Services Administration (HRSA) Division of Transplantation, and is currently operated by the Chronic Disease Research Group (CDRG), a division of the Hennepin Healthcare Research Institute in Minneapolis.[1][2]

The SRTR publishes program-specific reports twice a year, maintains the long-term transplant outcomes database, and co-produces the OPTN/SRTR Annual Data Report (ADR) with the OPTN.[2][3] Its best-known public-facing product is a five-tier star-style rating of transplant programs (not OPOs).[4][5]

Organization and oversight

The SRTR was established in 1987 and was initially operated by the United Network for Organ Sharing under HHS contract; the contract was competitively awarded to a different organization in 2000.[6] It is presently run by the Chronic Disease Research Group of the Hennepin Healthcare Research Institute (often shortened to CDRG/HHRI; it is not the "Minneapolis Medical Research Foundation," a common mislabel).[1] HRSA's Division of Transplantation oversees the SRTR contract alongside the OPTN contract, and the SRTR's data derive substantially from OPTN data submitted by member transplant programs and OPOs.[1][2]

What the SRTR measures

For transplant programs, the SRTR estimates risk-adjusted performance on a set of outcomes, principally:[2][4]

• Waitlist mortality rate (deaths among candidates while waiting),
• Transplant rate (the rate at which candidates receive transplants), and
• One-year graft survival (and patient survival) after transplant.

These metrics are reported relative to expected values derived from national risk-adjustment models, so that programs are compared against what would be predicted given their patient and donor mix.[2][4]

The five-tier rating system

In December 2016, the SRTR introduced a five-tier rating system to categorize program performance, replacing an earlier three-tier scheme.[4][5] The tiers run from tier 1 (worst) to tier 5 (best):[5][4]

• Tier 5, performing better than expected (best),
• Tier 4, somewhat better than expected,
• Tier 3, as expected,
• Tier 2, somewhat worse than expected,
• Tier 1, worse than expected (worst).

The methodology and rationale for the five-tier scheme were described by Wey and colleagues in Health Services Research (2018).[7] The rating applies to transplant programs, not to OPOs (OPOs are evaluated separately by CMS under 42 CFR Part 486; see Organ procurement organization).[4]

Surveys of transplant centers have documented mixed reactions to the five-tier system, with a majority of responding programs reporting at least one perceived negative effect (such as patient or insurer attrition or heightened caution in accepting higher-risk candidates).[8] Editors should present such effects neutrally and cite the underlying study.

OPTN/SRTR Annual Data Report

Each year the SRTR and the OPTN jointly publish the OPTN/SRTR Annual Data Report (ADR), a comprehensive statistical account of deceased and living donation, the waiting list, transplant volumes, and outcomes by organ.[3] The most recent edition is the 2024 Annual Data Report, published organ-by-organ in the American Journal of Transplantation.[3]

See also

• Organ Procurement and Transplantation Network (OPTN)
• United Network for Organ Sharing (UNOS)
• HRSA Division of Transplantation
• Organ procurement organization (OPO)
• The organ donation gap / national transplant waiting list

References

• Hennepin Healthcare Research Institute. Scientific Registry of Transplant Recipients (SRTR). https://www.hhrinstitute.org/our-research/scientific-registry-of-transplant-recipients/
• SRTR. About SRTR, Mission, vision, and values. https://www.srtr.org/about-srtr/mission-vision-and-values/
• American Journal of Transplantation. OPTN/SRTR 2024 Annual Data Report. https://www.amjtransplant.org/issue/S1600-6135(26)X0003-1
• SRTR. 5-Tier Outcome Assessment. https://www.srtr.org/about-the-data/guide-to-using-the-srtr-website/txguidearticles/5-tier-outcome-assessment/
• SRTR. 5-Tier FAQ. https://www.srtr.org/about-the-data/guide-to-using-the-srtr-website/txguidearticles/tier-faq-page/
• SRTR. The SRTR database / history. https://www.srtr.org/about-the-data/the-srtr-database/
• Wey A, Salkowski N, Kremers WK, et al. A five-tier system for improving the categorization of transplant program performance. Health Serv Res. 2018;53(3):1979-1991. PMID 28560726; doi:10.1111/1475-6773.12726. https://www.srtr.org/media/1321/wey-a_five-tier-system-for-rating-transplant-program-performance_2018-health-serv-res.pdf
• Schold JD, et al. Reported effects of the SRTR 5-tier rating system on US transplant centers: results of a national survey. Clin Transplant. 2018. PMC6219856. https://pmc.ncbi.nlm.nih.gov/articles/PMC6219856/