Why Standardization Matters in Organ Donation and Transplantation

Organ Procurement Organizations (OPOs) are driven by their mission to honor the generosity of organ donors and save the lives of patients awaiting a lifesaving organ transplant. When donors and their families make the extraordinary decision to give others a second chance at life, OPOs uphold a promise to support and advocate for them with compassion and ensure every safeguard and protocol is followed.

Standardization in the nation’s organ donation and transplantation system is critical to maintaining public trust. Clear, consistent practices strengthen public confidence and create predictability for families, hospitals, OPOs, and transplant centers. After 14 years of consecutive growth, recent declines in deceased donation rates signal the need for renewed focus and shared accountability. If donation falters, transplantation falters – and the stability of the current system is at stake.

Leading the Next Era of Improvement

AOPO is leading the next era of donation and transplantation by focusing on continuous innovation, transparency, and patient safety, in order to rebuild public trust in the donation and transplantation system. Through collaborative task forces and engagement of outside experts, such as Econometrica, Inc. and Rubrum Advising, AOPO is advancing alignment across several key areas.

• • • Donation after Circulatory Death (DCD)
    • Normothermic Regional Perfusion (NRP)
    • Donor Management
    • Donor Care Units (DCUs)
    • OPO Performance and Validated Metrics

Together, these efforts reflect a unified goal to strengthen the system through cohesion and measurable improvement.

Driving Consistency in DCD Practices

Donation after Circulatory Death (DCD), the method through which organ donation first began, now accounts for nearly half of all donation cases nationwide. Identified by federal agencies and the National Academies for Science, Engineering, and Medicine (NASEM) as the primary pathway to increase donation and transplantation rates in the U.S., DCD has expanded rapidly in recent years.

With growth comes the need for clarity. AOPO partnered with Rubrum Advising to bring together the Organ Donation Council with leadership and expertise from physicians, quality improvement staff, anesthesiologists, critical care physicians, ethicists, nurses, donor families, and OPOs to develop unified practices among stakeholders. This work includes outlining proposed policy actions, defining stakeholder responsibilities, establishing communication strategies, and reinforcing public trust around how DCD is conducted.

Establishing Guidelines for NRP

Advancements such as Normothermic Regional Perfusion (NRP) and Normothermic Machine Perfusion (NMP) are expanding donation opportunities that historically were not possible, especially in DCD cases. As with any emerging clinical innovation, these techniques must be applied safely and consistently.

AOPO’s NRP Task Force is developing aligned practices, overarching principles, and communication guidance to ensure NRP is implemented responsibly and ethically. This work aims to balance innovation with integrity – preserving the public trust while maximizing lifesaving potential.

Clinical Excellence in Donor Management

Effective critical care management, the clinical practice of preserving the health of potential organ donors, significantly increase the number of transplantable organs and enhances outcomes after transplantation. This involves targeted therapeutic interventions to maintain organ function following the declaration of brain death or the expectation of circulatory death.

AOPO OPO Medical Directors are working to establish uniform protocols for key aspects of donor management, including medical optimization, hemodynamic stabilization, ventilation and oxygenation strategies, fluid and electrolyte management, and other critical areas.

Building the Future of Donor Care Units

Across the nation, OPOs are increasingly establishing Donor Care Units (DCUs) – specialized units where donors can be transferred to facilitate the donation process without occupying space in hospital intensive care units or surgical suites. DCUs come in various models, including independent facilities operated by OPOs, dedicated units within hospitals, or community-based centers.

AOPO’s DCU Task Force is creating guidelines for these units, addressing infrastructure, staffing, logistics, and family support to ensure consistent, high-quality care nationwide.

Benefits of DCUs include:

• • • Streamlining the organ donation process and relieving hospital burden
    • Improving donor management to increase organ yield and viability
    • Providing a supportive environment for the donor family

Continuing to Focus on OPO IMPACT

A Standards Task Force has been established under the IMPACT Committee to advance and refine frameworks that support OPOs in strengthening quality and implementing evidence-based practices. Building on this foundation, the IMPACT Committee will continue to review and maintain the agreed upon successful practices to further guide and sustain ongoing improvement efforts across OPOs.

Measuring What Matters: Validated Metrics

In partnership with Econometrica, Inc., a data science and analytics firm, AOPO is also supporting the development of independently validated OPO metrics to strengthen accountability and trust ahead of the 2027–2030 OPO Centers for Medicare and Medicaid Services’ (CMS) recertification cycle. With 53 of 55 OPOs participating, this collaborative effort builds on CMS’ framework while incorporating recommendations from the NASEM report, Realizing the Promise of Equity in the Organ Transplantation System, and other insights from OPO site-visits and research.

Guiding Reform Through Collaboration

AOPO is a longtime proponent of innovation in the donation and transplantation system and has supported the Health Resources and Services Administration’s (HRSA) effort to modernize and strengthen our current system. Our association has been an active participant in discourse on changes to the field, proactively raising our concerns and sharing solutions on various issues over the years.

AOPO has engaged HRSA, Congress, and other stakeholders to ensure reforms are implemented responsibly and transparently. Key areas of focus include policies such as rescue pathway allocation and NRP, which are essential to protecting patient safety, upholding system integrity, and reinforcing public confidence in the national donation and transplantation system.

With continued partnership across the field, AOPO is committed to implementing additional system-wide reforms to achieve the goal of 50,000 annual organ transplants in 2026 – a milestone that will mark the next era of donation and transplantation.

A Unified Mission & Call to Action

AOPO and its members are invested in strengthening and enhancing a culture of exceptional performance to save lives. Harmonization, actionable metrics, and shared commitment ensure OPOs will continue to improve and meet the needs of donor families, transplant recipients, and the broader community.

AOPO’s overriding principle is simple – when the system works together under consistent processes, every donor’s gift can reach its full potential. Through collaboration, transparency, and data-driven improvement, AOPO and its members will continue advancing a trusted, unified donation and transplantation system that saves lives every day.

Thank you,
Steve Miller, MBA, CAE
AOPO CEO