AOPO Statement

“Tonya Ingram Feared the Organ Donation System Would Kill Her. It Did”
The New York Times | January 28, 2023

The Association of Organ Procurement Organizations (AOPO) is saddened by the news of Tonya Ingram’s death. Sadly, 17 people die each day waiting for a lifesaving transplant. There is no question that Americans, especially those suffering from acute kidney disease, deserve greater access to organs for transplant. However, the New York Times op-ed of Saturday, January 28, was grossly misleading and falsely placed all the responsibility on organ procurement organizations (OPOs) while ignoring critical, verified facts about why more organs are not transplanted.

OPOs, the non-profit entities federally designated to facilitate the recovery of organs from deceased donors, have been working for decades to bridge the gap between the availability of organs and the growing need for organ transplants in the U.S. Recent data released by the Organ Procurement and Transplantation Network (OPTN) shows how these efforts have resulted in an increase in the number of deceased organ donors year over year for the last 12 consecutive years. Since 2010, the data represents an 87% increase overall in deceased organ donors.

Notably, in 2022, OPOs recovered a record number of kidneys from deceased donors resulting in over 25,000 kidney transplants. These numbers show improvement and support that the U.S. is the world’s most successful organ donation and transplantation system. However, as long as there are patients waiting, there is more to do. A key area for improvement is in the number of organs that are recovered by OPOs but declined by transplant centers and go to waste instead. That number is rising dramatically. In fact, 7,543 kidneys, amounting to 26.6% of all kidneys recovered and offered by OPOs for transplantation in the U.S., were turned down by transplant centers last year.

In Los Angeles, where Tonya Ingram lived, organ donation was up 10% last year – a two-decade upward trend. The local OPO recovered a record 2,143 organs in 2022 but also saw 520 organs declined by transplant centers, up from 376 the year before. Moreover, 397 of the 520 rejected organs were kidneys, up from 273 the year before. This rise in organ decline rates is disheartening to the OPOs that work each day to increase the number of organs they are recovering. But it is devastating to patients living – and often dying – on dialysis, waiting for an organ. One of these kidneys may have saved Tonya’s life.

OPOs have no control over whether organs are actually transplanted into patients. Our nation’s transplant centers make this critical decision, determining whether to accept an organ offered from an OPO. The exclusion from this discussion of our nation’s transplant centers and their regulators as important stakeholders involved in improving the system’s ability to save more lives is a serious oversight. For the entire system to save more lives, we need to ensure that transplant centers have declared clear organ acceptance criteria, have the appropriate resources to process the influx of available organs, and utilize organs from more medically complex donors.

The National Academy of Science, Engineering, and Medicine’s (NASEM) report – “Realizing the Promise of Equity in the Organ Transplantation System” – which was developed in 2021 at the request of Congress and sponsored by the National Institutes of Health (NIH) is the only peer-reviewed, data-driven assessment of the entire organ donation and transplantation system, and it focuses specifically on kidneys. The report categorically states that the whole system – the Center for Medicare and Medicaid Services (CMS), the United Network for Organ Sharing (UNOS), transplant centers, OPOs, and donor hospitals – bears responsibility for increasing the number of transplants in the U.S.

NASEM found that “on average, patients who die waiting for a kidney had offers for 16 kidneys that were ultimately transplanted into other patients, indicating that many transplant centers refuse viable kidney offers on behalf of those on the waiting list (Husain et al., 2019).” According to the report: “The rate at which kidneys go unused in the United States is much higher than other developed countries (Mohan et al., 2018; Stewart et al., 2017). For example, the U.S. rate of nonuse for procured organs is nearly double the rate in France (Aubert et al., 2019). Approximately 62% of kidneys not used in the U.S. would likely have been successfully transplanted in France (Aubert et al., 2019).”

The nonuse of kidneys by transplant centers continues to rise, resulting in tragic consequences for patients and their families. Using the NASEM report’s estimate, if 62% of the 7,543 kidneys that transplant centers turned down in 2022 were transplanted instead, an additional 4,676 kidney patients would have been saved. The NASEM report provides a clear roadmap for achieving better outcomes for those who are awaiting a kidney transplant, as well as those in need of a kidney transplant who are not yet listed.

Rather than referencing NASEM, however, the New York Times op-ed relies on the privately funded Bridgespan study from 2019, which claims that OPOs fail to recover an additional 28,000 organs a year. This estimate is unrealistic and would only be possible if all potential organ donors said yes to donation, all their organs were medically suitable for transplant, and transplant centers accepted and successfully transplanted all their organs. The report notes that the figures represent the “full potential” of the system, assuming 100% donation rates and 100% organ utilization, an unfeasible measure in the medical field.

OPOs nationwide are unwavering in their commitment to saving patients’ lives and reducing the numbers on the waiting list. Every day, no matter the hour, they are called upon to approach families at the height of their grief and walk them through the decision to donate. In addition, every OPO employee comes to work each day because they know the suffering of those on the waiting list and want to help relieve it.

Our mission is to save more lives every day, yet we understand that collaboration is the only real way to achieve true improvement. Every organization in the system must acknowledge and bear responsibility for the part it plays and the changes it must make to increase the number of transplants. Too many patients have put their faith in our system for anyone to waste another minute avoiding responsibility or spreading falsehoods. It is important to explore the realities of our complex system, the challenges faced in saving more lives, and how all stakeholders must actively participate in reform.

AOPO and its member OPOs are working to increase the number of lives saved through our 50,000 annually organ transplants in 2026 goal, focused on expanding collaboration, improving equity, maximizing organ utilization, and driving innovation and research. Every American can help ensure that more organs are available for transplantation by registering as an organ, eye, and tissue donors at RegisterMe.org.