The U.S. has a deadly shortage of donor kidneys, livers and other organs for transplant. The wait list is about 110,000 patients long, and every day 20 people die before their names come up. So it came as good news late last year, when the Trump administration set a new policy to demand more efficient service from the regional agencies that obtain and deliver deceased-donor organs for transplant.
This policy, which had been scheduled to take effect on Feb. 1, has been delayed — like many other late-breaking federal rule changes from the previous White House — so that President Joe Biden’s administration can review it. Xavier Becerra, who has just been confirmed as secretary of Health and Human Services, should quickly put the organ-donation policy back on track, because it stands to save some 7,000 lives and $1 billion in Medicare spending (on kidney dialysis) each year and, in the bargain, redress racial disparities in the U.S. organ transplant system.
The regulation in question challenges the more than 50 federally certified Organ Procurement Organizations, each of which is granted a regional monopoly, to meet a performance benchmark for rates of organ donation and transplantation. It sets a minimum standard based on rates achieved by the 25 percent best-performing OPOs, using data collected by the Centers for Disease Control. Up to now, the government has relied on data provided by the OPOs themselves, so it isn’t surprising that no OPO has ever lost its certification.
Yet many have performed poorly. Even as advances in transplant science have expanded the pool of potential deceased donors, OPOs are recovering only about one in five potential donor organs. They have often failed to work diligently with hospitals to identify donors, or with families to obtain permissions for donation.
This inefficiency has proved most deadly for Black, Hispanic and Native Americans — populations that are especially likely to need organ transplants, and significantly less likely than white Americans to receive them. This may be in part because non-white families are less often brought into conversations about organ donation.
Not all OPOs are bad at their job. Indeed, performance varies dramatically across the system, with the top agencies accomplishing more than 21 transplants per 100 hospital inpatient deaths — almost five times as many as the least-effective agencies. If HHS were to decertify those that fail to measure up, the more competent ones could take over their areas and improve transplantation rates.
The OPOs have argued that they are improperly being held responsible for inefficiencies that afflict the wider transplantation system. No doubt, broader systemwide improvements could also be made. But that’s no reason to delay holding individual procurement organizations more accountable.