Reforms to Organ Donor System Would Save Thousands of Lives, Millions in Taxpayer Dollars Annually
A recent investigation found that reforming the little-known network of government-created monopolies responsible for providing organs to transplant recipients could double the number of lifesaving transplants performed each year.
Like many readers from the medical transplant field, I was not surprised by the shortcomings of Organ Procurement Organizations (OPOs) detailed in the report. In my 40 years as a transplant surgeon at Baylor University Medical Center in Dallas, I have too often seen the failures of our current system of obtaining and transplanting lifesaving organs.
Transplant centers rely on OPOs to recover the organs we need to save our patients. When someone dies in a manner that is medically suitable for organ donation, the OPO’s role is to arrive at the hospital and to provide the surviving family with all of the information needed to make a decision.
If the OPO does not do its job, the transplant center has no other legal or ethical means of acquiring an organ – which means one fewer of my patients has the chance to live. The issue is how OPOs are regulated and overseen – or, more precisely, the issue is their lack of oversight.
OPOs operate as unchecked regional monopolies, surrounded by a protective moat of soft reporting standards. The key metric by which they are evaluated is called their “conversion rate,” which refers to the percentage of eligible donors whose families consent to donate.
Historically, our standard was to report the number of donors per 1 million of population served, a benchmark used internationally. However, some 15 years ago, as OPOs saw that their recovery statistics were poor and a possible threat to their monopolies over the procurement business, they came up with a new metric: the number of actual donors per “eligible donors” that has become the standard performance metric in the United States.
The reality is that OPOs are able to self-interpret the definition of “eligible” on a case-by-case basis. If the OPO fails to obtain consent from a donor family, it can exploit any number of loopholes to avoid having to report the donor as ever having been “eligible” in the first place. It is as if working people would be allowed to fill out their 1099 Tax Form themselves – there would not many taxes paid in the US.
As a result, in the 35 years of self-reporting, not a single OPO has ever lost its government-granted designated service area.
Policymakers have resigned themselves to the idea that the number of organs OPOs recover is a fixed pool, and transplant centers from different states have been left to fight with each other over who gets to receive a bigger piece of the pie. But this just isn’t the case.
New research funded by the Laura and John Arnold Foundation indicates that we can have as many as 28,000 more organ transplants per year, enough to eliminate the national waiting lists for lungs and livers within just two years.
So why not focus on actually fixing the real underlying problem? Ninety-five percent of Americans already support organ donation. The bottleneck is not public sentiment, but rather OPO inefficiency and ineffectiveness.
The solution is straightforward. The U.S. Department of Health and Human Services should set clear, objective standards by which OPOs are evaluated, such as the number of donors per death in an OPO’s service area, data which is already publicly reported. Then, with this clearer picture of OPO performance, HHS can, for the first time, hold underperforming OPOs accountable for poor performance, ensuring first and foremost that the patients’ interests are served.
The fight should not be to ship organs from OPOs and regions where they work hard and do a good job to regions with chronically underperforming OPOs. Instead, we should work to ensure that all OPOs do their job of recovering organs from as many donors as they can to ensure that we save as many lives as possible.
Dr. Göran B. Klintmalm is an internationally recognized pioneer in organ transplantation. He performed the first liver transplant in Texas at Baylor University Medical Center, where he continues to serve as Chief of Transplantations, nearly 30 years ago. He is the former President of the American Society of Transplant Surgeons.