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Editor's Note: Colleen McCarthy is president of the Association of Organ Procurement Organizations, a nonprofit trade organization that leads America's organ donation community. She also serves as vice president of organ and tissue donation at Versiti Wisconsin, a federally designated organ procurement organization.
When we register as organ donors, we hope that our donations will ultimately save lives. However, almost 20% of organ donations remain unused. Last year alone, more than 10,000 organs were recovered from generous donors, including more than 8,500 kidneys. have not been transplanted into patients.
Recently, two separate transplants programs were farm due to concerns about their inability to transplant enough patients. The issue has even caught the attention of CMS, which plans to financially incentivize transplant centers to accept more organs through its recently announced program. Model of increasing access to organ transplantsor IOTA.
The “non-utilization” of organs is increasing and has become the main problem that the national organ donation and transplantation system must solve.
It is important to note that organ procurement organizations, or OPOs, that offer organs to transplant centers use established criteria to determine their suitability for transplantation. In the United States, deceased organ donation has grown for 13 consecutive years. Following a 2020 guideline from CMS, this upward trend continues, with OPOs allowing donation and harvesting more organs than ever before. Therefore, quality organs are available, but they are rejected for transplantation.
Why, then, do thousands of these organs remain unused, equating to thousands of patients being denied transplants or experiencing unnecessary delays in receiving them?
On the one hand, transplant centers are under great pressure to guarantee patients' survival for a year after surgery, and commercial insurers still use this measure to determine which centers are allowed in their networks – thus discouraging many surgeons to take risks on many organs unless they do. are close to perfection.
Hence an increase in the non-use of organs.
Non-utilization is a major concern for system stakeholders, particularly OPOs, who are now partially evaluated on their “transplant rate” – the number of organs successfully retrieved and transplanted. This measure depends on the acceptance by the transplant centers of the organs proposed by the OPOs. Non-use negatively affects the situation of OPOs and could ultimately lead to their closure, causing significant disruption to the donation process.
OPOs send out hundreds of thousands of offers for unused organs. According to a 2019 studyPatients who die while waiting for a kidney transplant receive an average of 16 organ offers over a 651-day period, most of which were declined on their behalf.
There must be a more effective way to align incentives between OPOs and transplant centers. As it stands, CMS has issued rules financially incentivizing transplant programs to grow through the IOTA model, while primarily incentivizing OPOs through the IOTA model. threat of immediate decertification.
However, the donation and transplantation community is not waiting for new policies to come into effect. They are taking matters into their own hands and uniting to put an end to this unnecessary waste.
In April, the first-ever Transplant Growth Collaborative brought together leaders from transplant centers, donor hospitals and OPOs from across the country. These stakeholders have always collaborated to ensure the maximum number of successful transplants for eligible patients. This conference focused on removing barriers to transplantation and finding new ways for programs to say “yes” to the organs offered to them.
DonorConnect, the OPO serving the Intermountain West, hosted the event and invited leaders of successful transplant programs from across the country to share their winning strategies. This included leaders of the liver transplant program at Intermountain Health, a nonprofit health system serving people in Utah and rural areas of Idaho, Nevada and Wyoming.
Among many impressive case studies, Intermountain's was particularly striking: a liver program that increased its transplant rate by 337% between 2018 and 2023.
As one of the only health care providers in much of its service area and one of the few to offer liver transplants, Intermountain identified its liver program as a growth site and committed to exceeding regional demand.
Program leadership developed a comprehensive plan to expand liver transplantation to senior hospital staff, presenting an approach that was both creative and collaborative. They presented a data-driven case that transplanting more patients with liver disease would not only significantly improve patients' health outcomes, but also create a positive ripple effect on their families and their communities.
After gaining support from senior leadership, program leaders were able to receive approval for the staff and resources they needed to succeed. They then deploy a triple growth strategy:
- Proactively increased staffing to support the increased workload, hiring additional anesthesiologists, surgeons, caregivers, and circulation managers trained to care for transplant patients, especially higher-risk patients.
- Raised awareness among the system's primary care physicians and specialists about when a patient with liver disease becomes a candidate for a transplant and increased the number of referrals to the waiting list; and partnered with its OPO, DonorConnect, to launch an online platform to streamline referrals and automate donor identification.
- Established new automated organ offer filters to identify organs the program was most likely to use, thereby maximizing the likelihood of obtaining strong matches for patients; and partnered with Intermountain Life Flight to charter its long-range medical jets to harvest organs across the United States.
The results were astounding. Intermountain Health's liver transplant program increased from 38 liver transplants in 2018 to 166 in 2023 – again, a 337 percent increase. This high performance sends a strong signal to providers, potential patients and their families that quality liver transplant care is fully achievable in the Intermountain West.
A common denominator among all transplant programs that have participated in the Transplant Growth Collaboration, and all successful transplant programs, is the willingness to accept – not avoid – calculated risk.
Effective programs know that risk aversion is both counterproductive and harmful to patients. Attempting to avoid risk by waiting for the perfect organ leads not only to the rejection of thousands of viable organs, but also to a much greater danger: that patients whose lives could have been saved will die while waiting.
This type of risk aversion is unnecessary. Medical advances in organ recovery and preservation have expanded the number of organs available for transplantation. Technologies now exist to revitalize imperfect organs and improve both the longevity and quality of organs from older donors.
Taking smart risks to increase transplants is not a responsibility that transplant centers should take on alone. The system-wide collaboration that has always characterized the field can enable real growth, and do so seamlessly. OPOs are invaluable partners for transplant centers to maximize organ utilization.
Last year, the number of deceased organ donations increased by 9.6%, resulting in more than 43,000 organs transplanted and saving lives. Even more can be done.
By sharing strategies that work, we can strengthen each other to take calculated risks, honor the gifts of organ donors, and help desperately ill patients recover. Together, we can solve one of the biggest challenges we face: organ disuse. We owe it to the more than 100,000 Americans on the transplant waiting list to continue working together until we get there.
Correction: A previous version of this story incorrectly stated the number of health care providers offering liver transplants in the Intermountain region. Intermountain Health is one of a handful of providers.