STATEMENT
Contact Information:
Jenny Daigle | jdaigle@aopo.org

AOPO Statement on Organ Transplantation Hearing by
House Energy and Commerce Subcommittee

McLean, VA. (Sept. 11, 2024) — On  September 11, 2024, the Oversight and Investigations Subcommittee of the U.S. House Committee on Energy and Commerce is scheduled to hold a hearing titled, “A Year Removed: Oversight of Securing the U.S. Organ Procurement and Transplantation Network Act Implementation.”

Based on the publicly available witness testimony, it appears that – once again – our lawmakers are being directed away from the truths about our system to instead discuss a litany of false, misleading, and unsupported allegations, featuring an unbalanced panel of witnesses who reinforce the narrative that erodes public trust in the organ transplantation system.

Stunningly, scant attention is given to the most alarming issue in transplantation today: the crisis of organ nonuse, in which thousands of transplantable organs go to waste every year. It’s a secondary loss to donor families and a tragedy for patients that die awaiting a life-saving transplant.

Today, OPOs are recovering enough organs that no one should die on the transplant waitlist. Yet these organs are not being transplanted.

This crisis is largely ignored even though solving it is the single fastest way to save the lives of people dying on the waiting list.

As the national non-profit organization representing 48 Organ Procurement Organizations (OPOs) across the U.S., the Association of Organ Procurement Organizations (AOPO) has a professional, moral, and ethical duty to shine a light on this growing crisis, which has gone unaddressed for far too long.

We are disheartened to learn that the focus of the hearing has shifted from a discussion of modernization efforts to focusing on OPOs, without notifying the national organization or inviting us to serve as a witness. It is unclear how a hearing can address organ donation and transplantation without including critical stakeholders. Despite our repeated requests for opportunities to contribute, we find ourselves left out of the conversation.

The information provided below was obtained from easily-sourced government data:

• • • In 2023, OPOs recovered over 43,000 organs from deceased donors for transplantation, marking 13 consecutive years of record growth and surpassing a goal set by the Centers for Medicare & Medicaid Services (CMS) to recover 41,000 organs by 2026.
    • In the same year, 3,803 kidney patients on the national waitlist died despite a surplus of transplantable organs.
    • 8,579 kidneys that were recovered by OPOs and offered to transplant programs were not accepted by these programs for their patients and ultimately became unviable. That represents over 28% of all kidneys recovered from deceased donors in 2023.
    • Those same 8,579 kidneys were offered by OPOs to transplant programs across the U.S. a total of 26,253,656 times before they became unviable and could not be used.
    • Overall, the nonuse rate of recovered kidneys has grown by 52% since 2016.

Government-funded research by the National Academies of Sciences, Engineering, and Medicine has highlighted the existence of a “weekend effect,” in which organs recovered during weekends are significantly less likely to be used by transplant centers than organs recovered during weekdays.

Furthermore, a 2019 study published in the Journal of the American Medical Association found that patients who die waiting for a kidney were offered a median of 16 kidneys that were ultimately transplanted into a patient lower on the wait list. Often the patients were unaware that the organs had been declined on their behalf.

This raises another critical issue – offering organs out of sequence. Each day, OPOs must offer an organ thousands of times to transplant programs across the country to find a center that will accept the organ for their matched patient. The longer the matching process takes, the less viable that organ becomes.

As the clock ticks and an organ is at risk of being unused, OPOs commonly resort to going “out of sequence” – which means offering the organ to a transplant center most likely to accept it so it will get transplanted. HRSA has long permitted this practice and easily sourced government data shows that organs offered based on their likelihood of acceptance by a transplant center are used at higher rates.

• • • Offering organs out of sequence is not ideal, however, because it can lead to inequitable distribution where some patients who are very sick or disadvantaged are not getting access to the organs they need. It remains a stop-gap measure for placing organs as the system seeks a longer-term solution to the nonuse crisis.

Solutions to nonuse – which are being vetted by HRSA’s Expeditious Task Force – have focused on making sure transplant programs are equipped with the necessary resources, policies, and best practices to accept the ever-growing surplus of organs recovered by OPOs. But last week, HRSA stopped a critical pilot program of the Expeditious Task Force that offers the greatest hope for saving more lives on the waiting list. We urge HRSA to allow the pilot to continue as solving the crisis of nonuse is the most immediate way we can save more lives through transplantation.

We urge the U.S. House Committee on Energy and Commerce to reject the divisive rhetoric preventing our system and its regulators from working together. Instead, we urge you to work with us in achieving the highly realistic goal of solving the national crisis of organ nonuse, which could quickly put an end to Americans dying unnecessarily on the waiting list.

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About the Association of Organ Procurement Organizations (AOPO)

The Association of Organ Procurement Organizations (AOPO) is the not-for-profit trade association leading the nation’s organ donation community to save and improve lives through organ, eye, and tissue donation. Founded in 1984, AOPO advances organ donation and transplantation by driving continual improvement of the donation process, collaborating with stakeholders, and sharing successful practices with its 48 member OPOs. AOPO envisions a future where every opportunity for donation results in lives saved. For more information, please visit www.aopo.org.