Health Affairs

Breaking Records In Organ Donations”, Health Affairs Forefront, April 17, 2023.
DOI: 10.1377/forefront.20230413.92437

Breaking Records In Organ Donations

Barry Massa, AOPO President
April 17, 2023

Organ donation and transplantation involve thousands of clinicians, professionals, and volunteers who collaborate to make the best use of a limited supply of organs. In 2022, 42,888 organ transplants were performed in the United States, an increase of 3.7 percent over 2021 and a new annual record, according to preliminary data from United Network for Organ Sharing.

Each organ transplant in the US begins with the professionals at the nation’s 56 nonprofit Organ Procurement Organizations (OPOs), who respond 24/7/365 when they learn from a local hospital that a patient is near death. Their role is to approach grieving families to discuss donation and, following donor registration confirmation or family consent, to then evaluate the organs and identify possible recipients on the waiting list. Organ offers are distributed to transplant centers with patient matches, and, once accepted, OPO teams recover the organs and quickly transport them to the transplant hospitals. Responsibility then shifts to the transplant team at the hospital, which preps the patient, conducts the complex, hours-long surgery, and oversees recovery post-transplant. In this way, 100-plus US lives are saved each day through transplants. Remarkably, up to 200 people can be involved in each transplant from start to finish.

Here, we describe some of the successes from the Association of Organ Procurement Organizations (AOPO) in collaboration with OPOs and system stakeholders. Through greater attention to reducing waste and increasing diversity, equity, and inclusion in organ donation, these wins can continue in years ahead.

The AOPO Model

The AOPO rang in 2023 by proudly celebrating a record number of lives saved through transplantation. In 2022, the organ donation community helped facilitate the recovery and transplant of 39,860 total organs from deceased donors, resulting in 36,421 lives saved—up 4.6 percent over 2021.

This growth in transplants—for the tenth year in a row—was not easily achieved. Thousands of people across the US who make up the organ donation and transplantation system continually seek ways to improve our technology, outreach, policies, and processes to save even more lives every day. The US system is the global model for organ donation and transplantation. Other nations look to us for direction on how to save more lives through donation, and we continue to lead the way.

The AOPO has set a goal of reaching 50,000 annual organ transplants in 2026. Advances in science and greater collaboration between all those involved in the process are quickly getting us there. Of our nation’s 56 OPOs, 42 increased deceased donor organ recoveries in 2022 over 2021, and 38 set all-time records. This is a testament to their decades worth of work and systemwide collaboration. OPOs have doubled down on supporting clinical advancements, increasing public awareness, and coordinating with the medical community so that when an opportunity for donation arises, they are quick to respond.

In 2022, donation after circulatory determination of death (DCDD) increased by 14 percent over 2021, while all deceased donors (DCDD and brain death combined) increased by 7.5 percent. Those figures speak to the success of the system, yet they also tell a deeper, more important story of generosity in the face of loss and of hope gratefully restored—for both organ recipients and donor families. Our community never forgets that these are the people we work for every day. And it is in their names and for their sakes that we are committed to continual improvement.

Looking Ahead

This year, our OPO community is laser-focused on implementing the recommendations of the National Academies of Sciences, Engineering, and Medicine (NASEM), which, at the request of Congress, recently conducted a comprehensive review of donor organ procurement, allocation, and distribution. The study made recommendations for the organ donation and transplantation community to improve equity and accountability systemwide.

Part of the NASEM report outlines recommendations for OPOs, specifically that we prioritize the creation of donor care units (DCUs). DCUs are specialized facilities at OPOs or donor hospitals where organ recovery can take place. NASEM encourages DCUs because they are dedicated, supportive spaces away from hospital intensive care units, which are more suitable environments for donors and their families. To date, 19 DCUs have been established by our nation’s OPOs, and there are plans to open more in the near future. We applaud our members for their determination to make this critical NASEM recommendation a reality.

DEI In Organ Donation

OPOs across the country also invest in Diversity, Equity and Inclusion (DEI) initiatives that align with NASEM recommendations, including work with federal policy makers to:

  1. Achieve equity in the transplantation system within the next five years,
  2. Set national goals for the transplant system,
  3. Create standardized metrics to measure equity in the transplantation process, and
  4. Incentivize improvements in transplant system performance and equity.

While this has long been a priority for our community, the need for increased outreach to diverse communities has become even more urgent in the past several years as our entire nation has awoken to the stark realities of public health inequity. The AOPO has formed a DEI Committee to align initiatives and share best practices across OPOs, surveying our members on communications, human resources, programming, training, and development.

On an even larger scale, the AOPO, the Organ Donation Advocacy Group, and individual OPOs have partnered with the nation’s four historically black college and university medical schools on an initiative to increase the number of Black organ donors and recipients in the US. This initiative includes four pilot programs in different US locations that aim to increase the pipeline of Black doctors and donation professionals and to deliver the message of organ donor registration to communities of color in more effective ways. We will begin sharing the results of these pilots later this year.

Reducing Waste

Additionally, the AOPO plans to work with our transplant partners this year to find ways to significantly increase the number of transplants. This will be done by reducing the needless non-use of thousands of viable organs that OPOs recover each year. This issue is a top priority in the NASEM report, which offers solutions to make it easier for transplant centers to say “yes” to organ offers. The recommended actions for transplant centers are to:

  1. Increase transparency and accountability for organ offer decisions and better communication with patients for shared decision making,
  2. Require smooth surgical scheduling to eliminate the “weekend effect” in which organs that become available on those days are less likely to be procured, accepted, or transplanted,
  3. Refine organ offer filters to allow centers to screen out donor characteristics they consider unsuitable and would not accept for transplant, and
  4. Implement expedited placement policies to reduce delays in allocation by routing medically complex organs to centers with a proven willingness to use them.

Each year, the number of recovered organs that go unused continues to rise; in 2022, 26 percent of kidneys were recovered and not placed, accounting for 7,547 kidneys nationwide. Industry data show that transplant centers are not accepting a percentage of less-than-perfect organs because they come from older and more medically complex donors. Yet, a recent study showed that 62 percent of the organs discarded in the US are of the same quality of organs successfully transplanted in France. This means 4,600-plus of donated kidneys discarded in 2022 in the US had a real potential of being transplanted. This is disheartening news to the OPOs that work so hard to recover organs, but it is devastating news to the Americans waiting—and sometimes dying—on dialysis because they are told there are no kidneys available for transplant.

The AOPO is committed to supporting members of our larger transplant community as they tackle this issue, as well as the other thoughtful and reasoned recommendations in the NASEM report. By prioritizing the NASEM recommendations, sharpening system performance, ensuring the use of available organs, and enhancing our longstanding partnerships, we will radically improve our system in the coming years and save more lives.