PUBLIC STATEMENT

Media Contact:
Jenny Daigle | jdaigle@aopo.org

AOPO Urges CMS to Protect System Stability and Donor Family Services in Response to IPPS Proposed Rule

McLean, VA (June 16, 2026) – On June 9, the Association of Organ Procurement Organizations (AOPO) submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) urging the agency to reconsider several aspects of its Fiscal Year 2027 Inpatient Prospective Payment Systems (IPPS) proposed rule.

While AOPO and its members share CMS’ commitment to accountability and transparency, our community is deeply concerned by proposed changes that threaten to destabilize the nation’s organ donation infrastructure, restrict vital support services for grieving donor families, limit public and professional education programs and stifle the continuous innovation needed to save more lives.

Organ donation requires 24/7 operational readiness from hospitals and organ procurement organizations (OPOs) nationwide. The proposed IPPS rule would fundamentally restructure the OPO reimbursement methodology making that possible. By shifting to a retrospective reconciliation model that effectively forces OPOs to operate on a zero-margin basis, the rule risks introducing extreme financial volatility to the highly complex and ever-evolving donation system.

Instead of investing in community and hospital education, grief resources for donor families or innovative technologies such as machine perfusion devices or advanced transportation logistics, OPOs would be required to reserve significant funds to cover reimbursement liabilities, limiting their ability to strengthen donation and transplantation services.

This financial restructuring would occur at the same time the donation system is already navigating significant changes impacting its long-term stability, as OPOs undergo an unprecedented recertification process that has raised concerns for years among surgeons, hospital leaders, researchers, patients and Members of Congress. Introducing drastic reimbursement changes during a period of regulatory uncertainty risks further disruptions that could jeopardize the care of over 100,000 patients currently awaiting a transplant.

Organ transplantation leaders also recognize these issues. On June 1, the American Society of Transplant Surgeons (ASTS) submitted comments to CMS expressing reservations with the IPPS rule being introduced and implemented during such a transitional period, warning that doing so could further destabilize organ procurement and interfere with patients’ access to organ transplants.

Regulators are also hearing directly from those most intimately involved in the donation process: the families of organ donors. Parents, siblings, and spouses among others have illustrated in their own comment letters that organ donation “is just as much a community-driven process as it is clinical.” In sharing their personal stories, they articulate how OPOs’ grief resources, remembrance events and volunteer programs helped donor families navigate unimaginable loss and find hope through our nation’s donation community. Some went on to share concerns that regulatory changes limiting OPOs from maintaining these programs would end the long-term support donor families need, dehumanize the donation process, and reduce opportunities to inspire future donors.

Policy changes should advance the goal of saving more lives through organ donation and transplantation. In order to protect the continuity of donation operations, AOPO recommends CMS consider alternative approaches including:

• • • Maintain the current reimbursement framework and utilize targeted oversight and audit mechanisms to effectively manage Medicare resources, rather than imposing universal retrospective reconciliation.
    • Decline to finalize a reimbursement methodology that effectively requires OPOs to operate with no margin or that applies broad reimbursement changes to allowable costs beyond services associated with Medicare transplant beneficiaries.
    • Explicitly protect funding for donor family and community services by recognizing donor family aftercare, bereavement programs, and public education as reasonable and necessary allowable costs that are essential to the donation mission.
    • Implement a phased transition and reasonable margin if structural payment changes are finalized. AOPO recommends that CMS should study reasonable margin approaches for organ-specific costs, including reviewing comparable policies for critical access hospitals and other reasonable cost-based reimbursement frameworks.

AOPO appreciates CMS’s ongoing engagement of stakeholders on these important issues, and looks forward to working with the agency to strengthen the nation’s donation system while preserving the trust, innovation, and operational readiness that make transplantation possible.

Each person who becomes an organ, eye, and tissue donor can save up to eight lives and heal more than 75. AOPO encourages everyone to learn more and consider signing up as a donor. You can register today by visiting RegisterMe.org/AOPO50K.