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.
National organ donation programmes help patients with failing organs receive life-saving transplants from willing donors. These programmes are complex and need many parts to work well together. It is possible to measure how well they work by tracking key numbers, such as how many transplants happen each year. Using several measures together helps stakeholders see how well a system works, how it compares with systems in other countries, how it changes over time, and where it needs to improve. The authors wanted to create a set of measures that can be used together to assess how well national organ donation programmes perform. The authors looked at organ donation programmes in Europe. First, the authors reviewed past research and reports to find possible measures. Then the authors worked with 24 experts from different European countries and fields. Over several rounds of discussion and ranking, the experts agreed on 84 measures for judging how well programmes perform. These measures cover all of the main parts of the process: tracking and reporting, preventing organ failure, managing waiting lists, getting consent, donation, transplants, and follow-up care for living donors and recipients. Many of these measures are already in use. Others focus on areas that have had less attention, such as gathering patients’ views in a structured way. This set of indicators can help policymakers assess how their country’s system is performing and identify where improvements are needed.
© The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd.