It’s time to overhaul the organ donation system
Organ donation is an incredibly selfless act, performed only in the most tragic of circumstances. But that’s not always possible, and the fact that more than 100,000 Americans are waiting for a vital organ makes any gift that much more valuable. That’s why those of us in the organ donation community should do everything in our power to get it right whenever donation is possible.
The failures of the US organ donation system have been the subject of great debate over the past three years, first highlighted in a 2019 executive order on promoting kidney health. Since then, the House Oversight Committee has conducted a bipartisan investigation into the inner workings of a number of organ donation agencies, known as organ procurement organizations. Medicare announced new performance metrics to hold underperforming OPOs accountable, with the threat of decertifying those who don’t improve performance enough by 2024. A hearing to highlight organizational failings it found in the Organ Supply and Transplantation Network, which oversees the US donation system and is operated under contract by the United Network for Organ Sharing. This bipartisan investigation revealed a number of seriously deficient operational areas at UNOS that are in desperate need of updating, leading one senator to assert that UNOS should lose its network operating contract. organ procurement and transplantation.
There is no doubt that system reforms and updated performance measures have been needed for some time. Many of us welcomed the increased oversight and scrutiny. And some early reforms have already borne fruit. With the threat of decertification looming, several organ procurement organizations have now changed their operations, in many cases with new processor leaders at the helm. Meanwhile, the CEO of UNOS recently announced his resignation, and new leadership could lead to that organization having to overhaul its operations or, like failing organ procurement organizations, losing its contract.
But while the potential decertification of organ procurement organizations and the threat of losing the Organ Procurement and Transplantation Network contract can lead to improvements, they are likely to be modest, isolated and temporary – and fall short of that. which is really possible. Instead, systemic changes are needed to revolutionize this work. Moreover, the decertification itself could end up doing more harm than needlessly good. Why abandon resources already accumulated in the national donation network through a process of decertification when Medicare could instead force a change in organizational direction through the mechanism of a restructuring agent? A change in leadership is the very thing that has had a positive impact on many failing organ harvesting operations to date.
It’s time for us to focus on the real things we need to do to transform the system itself.
Much of the problem today rests on a lack of up-to-date and integrated technology, inconsistent definitions and data collection, and the unwillingness of many to embrace transparency and accountability. Despite technological advances in many other areas of health care, organ procurement and transplantation systems are outdated and woefully inadequate, as a recent audit conducted by the US Digital Service revealed. Most organ procurement organizations’ systems are embarrassingly simple and offer no platform to capture data consistently or efficiently. Many of these organizations today continue to oppose public disclosure of their data. And organ procurement organizations and organ procurement and transplantation network systems are not able to integrate with the overall healthcare information technology infrastructure. In 2022, we are still manually entering the same information multiple times into several different systems, which is not only inefficient, but also regularly leads to errors that can mean the life or death of waiting patients.
Four years ago, as an individual organ procurement organization, we led the way with the nation’s first automated electronic referral system. More recently, we were also able to develop a system to access organ donor information from multiple sources as a participant in the health information exchange. We all need to expend energy and resources now to capitalize on these types of transformational work.
The other part of the problem today is cultural. Many engaged in this work have become undeniably complacent, others have become selfish protectionists resistant to change, and still others have become outright bullies, resorting to intimidation, threats and gaslighting. when others dare to speak. All of this became abundantly and painfully clear at a recent Senate Finance Committee hearing, and it must end.
Organ donation as a segment of healthcare only exists today because more than 50 years ago, healthcare professionals were driven, open and innovative advocates who constantly asked “and if” and “why not” and refused to accept the idea that something was not possible. , authorized or worthy of prosecution. This innovative and inclusive spirit must be revived today.
The need for transformative leadership and solutions in a truly innovative culture is what led five of us in the OPO community to form the Organ Donation Consortium this year. Our strategic focus is technology innovations and integrations, cross-industry stakeholder collaboration, and transparent accountability. Through our work, we set out to save more lives through organ donation while eliminating health disparities and providing a framework for the consistent and reliable collection of data for performance measurement and improvement. keep on going.
The current investigations into the US organ donation system by the Biden administration and Congress are needed and long overdue. The immediate remedies they seek, including the decertification of organ harvesting organizations, may do isolated and temporary good today, but are unlikely to lead to lasting change with long-term effect. Instead, the system needs transformative solutions. Donors and their grieving family members deserve it, and patients die every day waiting for us to act. It’s time we all got to work.
Bradley L. Adams is president of the Southwest Transplant Alliance, the Dallas-based organ procurement organization serving more than 10.5 million Texans. He wrote this column for The Dallas Morning News.
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