AOPO Addresses Information in Senate Finance Committee Hearing & Report on Organ Transplantation
The Association of Organ Procurement Organizations (AOPO) filed a statement with the Senate Finance Committee sharing its views on its recent hearing and report on organ procurement and transplantation. The report, “A System in Need of Repair: Addressing Organizational Failures in the U.S. Organ Procurement and Transplantation Network (OPTN),” contained some misinformation that we felt was important to clarify. We are open to working collaboratively with the Committee and we share their goal of creating and maintaining a more efficient donation and transplantation system.
In our statement, we pointed to the recent National Academies of Sciences, Engineering, and Medicine (NASEM) report, which includes a thorough assessment of the current state of the organ donation and transplantation system and provides recommendations to establish a more effective and equitable system. The recommendations align with our goal to achieve 50,000 annual organ transplants in 2026 by expanding collaboration with stakeholders, reducing health inequities, increasing organ utilization, and driving innovation and research.
Organ Acceptance Rates and Non-Utilization
We told the Committee that the underuse of viable organs is an urgent issue and contributing factor to the nationwide waitlist exceeding 100,000 patients. According to research cited in the NASEM report, a person who dies on the waitlist has, on average, been offered 16 organs. Transplant centers need to increase their organ acceptance rates by accepting organs from older and more medically complex donors.
Between 2018 and 2020, the number of donor kidneys not transplanted increased by 34%, partly due to low acceptance rates and high variability in acceptance practices across transplant programs. AOPO supports implementing a robust system to document the cause of every organ which is not utilized and implement strategies to increase organ acceptance and minimize organ waste. For example, advancements in and the usage of screening tools could reduce the number of patients offered an organ with a known deferral, expediting the matching process and lowering the number of organs not transplanted.
System Efficiency and Performance
The Senate Finance Committee report references the non-peer reviewed Bridgespan report, which claims that more than 28,000 additional organs could be transplanted each year. We once again rebut this as unvalidated based on a 100% donation and utilization rate of organs. Some organs are simply not safe for transplant.
The report also states that under the final rule, 22 out of 57 OPOs would fail the new outcome measures and be decertified. We believe that the new methodology used in the evaluation of organ procurement organization (OPO) performance is a comparative measure defining the bar to “pass” as the top 25th percentile. Therefore, by design, the metrics can result in OPOs being assigned to lower performance tiers subject to possible decertification or competition, regardless of continued improved performance over the certification cycle.
The Senate Finance Committee report also states that 249 recipients experienced disease transmission following an organ transplant or an error in blood typing, and 70 recipients died due to failures in the donation and transplantation system. Any death that results from an error is tragic and the system must and does ensure that when errors occur, they are reviewed, understood, and steps are taken to prevent them in the future. Even with systems in place, the risk will never be zero.
The numbers the Committee reported represent .03% of the 231,180 organs transplanted over the indicated seven-year period. The numbers show that nearly 99.9% of transplants resulted in successful outcomes and did not result in illness or death due to infected organs. We believe this very small risk must be understood in the context of the extremely high risk of death from organ failure for patients not being transplanted. We told the Committee that OPOs conduct multiple tests, many of which are guided by transplant centers, for every organ donor to identify the potential for disease transmission and other safety issues. The Organ Procurement Transplant Network (OPTN)/United Network of Organ Sharing also require safeguards.
With mere hours to transplant life-saving organs after recovery, reliable transportation is essential to the organ donation and transplantation process. We discussed how OPOs are tasked with determining the safest and quickest way to transport donor organs. While even one organ lost or damaged in transport is too many, the transit incidents covered in this report are extremely rare, and something OPOs have actively implemented mechanisms to avoid.
We pointed out that OPOs are collaborating with companies offering organ tracking technology, which has helped improve transportation logistics and efficiencies between the donor hospital and transplant center. Likewise, OPOs are partnering with companies to expedite air and ground transportation of organs. Undoubtedly, additional tools to support transportation from the OPTN and Federal Aviation Agency (FAA) regulations will improve transit efficiencies between donor hospitals and transplant centers.
In closing, 2021 marked the eleventh consecutive year for increases in deceased organ donors and the ninth consecutive year of increases in the number of organ transplants nationwide. We agree that by investing in new, promising technologies, aligning policies and metrics toward shared, system-wide goals, and establishing mutual accountability for participants in the organ donation and transplantation process, we can improve the efficiency and equality of our system and ultimately save more lives.
Steve Miller, MBA, CAE