Public reporting of outcomes does not change patient selection at transplant centers
July 2026
Public reporting of health care outcomes is intended to improve transparency and quality of care. However, this could also encourage health care providers to avoid treating higher-risk patients to protect their outcomes. If providers become more selective about the patients they treat, this could limit access for patients who need transplant care the most.
Background
In 2021, the TRANSPLANT Act required public reporting for all relevant clinical outcomes for U.S. centers that perform allogeneic hematopoietic cell transplantation (alloHCT). As a result, CIBMTR® (Center for International Blood and Marrow Transplant Research®) began assigning transplant centers a score based on a comparison of its actual vs. expected patient survival rate based on the complexity of their specific cases (-1 below expected, 0 as expected, +1 above expected).
To understand if publicly reported outcomes influence the patients that centers chose to transplant, researchers compared centers who performed below expectation vs. those who didn’t.
Methods
Data were drawn from annual center-specific survival analysis (CSA) reports of U.S. transplant centers. Centers were categorized into two groups:
- Newly below-expected centers (NBCs): Centers that received a -1, below expected, survival score after previously scoring as expected (0) or above (+1).
- Control centers: Centers that consistently scored as expected (received a score of 0).
Changes in eight patient characteristics (age, comorbidity burden, disease status, race, donor type, graft source, conditioning intensity and performance status) were assessed. Comparisons were made three years before vs. three years after receiving a performance score.
Results
Findings showed no significant differences in patient selection behavior between NBCs and control centers. Higher-risk patient characteristics (e.g., older age, more comorbidities, advanced disease) rose at similar rates across both center types, indicating that low-scoring centers did not avoid higher-risk patients.
In terms of survival outcomes, both NBCs and control centers showed:
- A similar increase in predicted and actual one-year survival:
- NBCs: +3.08%, p<0.01
- Controls: +3.30%, p<0.01
- An increase in one-year overall survival (OS), with a nonsignificant difference between them:
- NBCs: +0.87%
- Controls: 4.52%
Taken together, these data indicate that NBCs did not shift towards selecting lower-risk patients. Overall, this study supports that mandating the public reporting of transplant outcomes does not reduce access for higher-risk patients.
Key takeaways
This study found that publicly reporting transplant outcomes did not reduce access to alloHCT for more complex or higher-risk patients. Centers that received below-expected survival scores continued to treat patients with similar levels of risk, showing no evidence that they avoided higher-risk cases or changed their patient selection practices. All centers showed improvements in OS outcomes over time.
Overall, these findings suggest that public reporting does not negatively impact equity or access to transplant, though ongoing monitoring remains important.