“OT in Aastha hospital, Power house road” by Sadasiv Swain is licensed under CC BY 2.0.

HHS can fix organ donation and save thousands of lives and billions of dollars

Bryan Sivak


Earlier this month, Secretary for Health and Human Services (HHS) Alex Azar said “[HHS is] going to look at how we can deliver more organs for transplants.” Executing on this simple statement could save thousands of lives each year and billions of dollars for the American taxpayer.

This is not an exaggeration. Ninety-five percent of Americans support organ donation but the US organ donation system is grossly inefficient. Roughly 115,000 people are currently languishing on the transplant waiting list, and thousands die every year while waiting.

In addition to the human toll, the lack of organs available for transplant is a major unseen driver of healthcare costs. More than eighty percent of people waiting for transplants need kidneys, and patients with end-stage renal disease account for more than $34 billion in Medicare costs, a full percent of the entire Federal budget.

Some issues are simply sound policy, regardless of political orientation, and helping more patients get organ transplants is one of them. I looked at this issue deeply while I served as the Chief Technology Officer at HHS under President Obama and HHS Secretary Sebelius, and applaud Secretary Azar for focusing on this issue.

To understand potential solutions it is first helpful to explain the problem. Most people believe that when they register as an organ donor, that is the end of the story; in truth, it’s only the beginning.

For an organ donation to occur — that is, for the donor’s wishes to be honored — the responsibility falls on a little-known network of 58 contractors called Organ Procurement Organizations (OPOs). While these OPOs perform an important service, they could be much more effective.

OPOs are regulated by the Centers for Medicare and Medicaid Services (CMS). Every four years, CMS determines whether an individual OPO is performing in accordance with regulations and determines whether or not to renew their contract.

In the current framework, OPOs are granted the ability to self-report their own performance metrics to CMS. Perhaps unsurprisingly, industry-wide performance is reported more favorably than demonstrated by objective data. It shouldn’t come as a surprise, then, as a former president of the American Society of Transplant Surgeons recently noted, “in the 35 years of self-reporting, not a single OPO has ever lost its government-granted designated service area.”

In fact, while OPOs generally report that they recover approximately 80 percent of potential donors, new research found that OPOs actually recover closer to 30–40% of potential donors in any given year.

A better functioning OPO system could recover as many as 28,000 additional organs every year, enough to more than double the number of kidney transplants. This would save tens of thousands of lives and $12 billion for taxpayers in just five years, and could even eliminate the waiting lists for lungs and livers entirely within just two years.

Earlier this month, leading patients’ groups wrote to CMS Administrator Seema Verma asking for OPO reform. In order to improve organ donation rates the first step is to increase OPO accountability.

This is a clear victory for patients, their families, and taxpayers alike, and there are straightforward solutions available. For example, HHS can move from OPO self-reported data to objective data, which can be easily done without adding any new reporting burden simply through leveraging data already reported to the Centers for Disease Control.

While many issues in healthcare are contentious, organ donation reform is a policy effort that can easily meet the so-called “triple aim” — better quality, better health, and lower cost. If Secretary Azar and Administrator Verma can see these reforms through, they will leave a lasting legacy for some of the country’s most vulnerable patients.