Long Overdue Improvements to the Accountability of the Organ Donation System are Timely, Fiscally
Responsible, Broadly Supported, and Critical to Saving Lives
Reforming the organ donation system could lead to 28,000 additional lifesaving transplants and save $12B over 5 years to Medicare
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The government monopoly contractors who run the organ donation system (Organ Procurement Organizations, OPOs) are massively underperforming according to December 2019 HHS proposed rule, which found more than half of OPOs out of compliance with proposed objective standards. (See red onvmap.) Secretary Azar: “ We’re going to stop looking the other way while lives are lost and hold OPOs accountable.”
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OPOs also have a documented history of fraud, waste and abuse. Yet CMS has not pulled a contract in decades because the current regulation is unenforceable. (See JAMA.)
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COVID-19 has increased urgency for reform as patients with organ failure are particularly at risk
Popular issue with broad-based coalition
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Politico: Organ donation reform is “arguably [President Trump’s] most popular public health effort, with bipartisan support for cracking down on the organ procurement organizations that are responsible for recovering organs.”
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New York Times editorial board: “an astounding lack of accountability and oversight in the nation’s creaking, monopolistic organ transplant system is allowing hundreds of thousands of potential organ donations to fall through the cracks.”
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Washington Post editorial board: “Much of this death and waiting is unnecessary, because the organs would be available if those responsible for collecting and transporting organs did a better job. It is past time the government demanded it of them.”
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Andy Slavitt and Adam Brandon: “Perhaps most upsetting is just how willing policymakers have been to tolerate [OPOs]. Despite gross underperformance, as well as this highly troubling financial impropriety, no OPO has lost a contract in decades.
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Ben Jealous, former NAACP President: “Astoundingly [OPOs] are also asking that the new standards not be implemented until 2026, during which time tens of thousands more patients — disproportionately people of color — would die."
Bipartisan Congressional support
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Senate Finance Committee, Senators Grassley, Wyden, Young, and Cardin initiated bipartisan oversight into OPOs and their oversight contractor, UNOS.
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Reps. Katie Porter and Karen Bass, Chair of the Congressional Black Caucus, urged HHS to move urgently to finalize the proposed rule.
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House Appropriations Committee: “The Committee supports efforts to establish objective outcome measures for Organ Procurement Organizations (OPO) as well as efforts to decertify underperforming OPOs at the conclusion of the current contract cycles"
To support patients, Congressional offices can urge HHS to finalize rule at the patient-centered standard from December 2019, holding OPOs accountable at the upcoming 2022 recertification cycle; and support ongoing Congressional oversight.