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May 13, 2021
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Organ procurement trade group loses members as US House committee begins investigation

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Six transplant donor groups broke away from their national trade association at the start of a U.S. House-led hearing earlier this month on whether the association was lobbying against new donor performance requirements.

The House Oversight and Reform Committee’s Subcommittee on Economic and Consumer Policy had requested records prior to the May 4 hearing from the Association of Organ Procurement Organizations (AOPO) and 11 of the 57 organ procurement organizations (OPOs) that have federal contracts and are members of the AOPO.

Steve Miller

“[We] received a letter from the House Oversight Subcommittee requesting documents and information about the activities of AOPO with respect to the proposed regulations,” Steve Miller, CEO of AOPO, told Healio Nephrology. “AOPO has been highly cooperative with the subcommittee, responding to each of its requests and producing thousands of pages of documents, as well as agreeing to testify at the hearing.”

The six OPOs that announced at the hearing they were leaving the AOPO included Louisiana Organ Procurement Agency, Life Connection of Ohio, Mid-America Transplant, LiveOnNY, OurLegacy and Southwest Transplant Alliance.

Matthew Wadsworth, CEO of Life Connection of Ohio, told Healio Nephrology the OPOs leaving AOPO were “re-allocating assets toward continued performance improvement through our innovation cohort with the Federation of American Scientists.

“I didn’t feel it was right to spend taxpayer dollars on lobbying efforts [by AOPO] against increased accountability and transparency,” Wadsworth said.

In a press release, Life Connection of Ohio said the recently published regulations “have received broad support from bipartisan congressional offices, patient advocates and health equity leaders ... With AOPO’s recent transition from a 501(c)(3) to a 501(c)(6) organization, its lobbying efforts against these regulations are in contrast with not only Life Connection of Ohio’s stance but also with the federally designated roles assigned to OPOs, including prioritizing patient outcomes.”

Miller told Healio Nephrology that despite irregularities in OPO performance, the organ donation effort in the United States is one of the most successful in the world.

“AOPO has long supported reform to create new and improved metrics that assess OPO performance to hold OPOs accountable for their role in the donation and transplantation process,” Miller wrote. “We agree there is room for improvement in OPO performance; however, the donation and transplantation system in the U.S. remains the highest performing in the world.”

New regulations

The new regulations are part of the Advancing American Kidney Health, an initiative launched in 2019 to improve care for patients with kidney disease. In announcing the final rule in November 2020 for OPOs, then HHS Secretary Alex Azar II said, “There are few more transformative interventions for someone’s health than an organ transplant, but thousands of Americans are deprived of this lifesaving opportunity every year by a broken system. By making overdue reforms to hold organ procurement organizations accountable, we are giving thousands of Americans waiting for organ transplants a chance at better, longer, and healthier lives,” he said.

The reforms include 12-month reviews of OPO performance in meeting donor procurement targets and publicly available rankings. In addition, changes have been made regarding how the donation rate is measured and how the transplantation rate is measured. OPOs will be divided into three tiers based on performance; those in the lowest tier will be decertified if they do not improve their donor rate, according to the regulations.

Rep. Raja Krishnamoorthi
Joe Ferreira

HHS estimates the changes could increase the number of organs available for transplant by 5,600 per year and that the annual number of transplants performed could increase from approximately 33,000 to 41,000 by 2026.

Subcommittee hearing

Rep. Raja Krishnamoorthi, D-Ill., chair of the House Subcommittee on Economic and Consumer Policy who led the May 4 hearing, said in a statement, “There is an urgent need to reform the organ transplantation system to secure more organs for waiting, ailing, and dying patients. For far too long, OPOs have faced no outside incentive to perform, evaded public scrutiny, refused to reveal data showing their success and failure; and hid behind a wall of jargon and obfuscation. For the patients who are ailing, I will not let OPOs keep failing them. Saving lives is above politics, and OPO reform is a bipartisan issue.”

During questioning, Joe Ferreira, AOPO president and CEO of Nevada Donor Network, acknowledged at the hearing his OPO does pay for season tickets to the Las Vegas Raiders professional football team and the Las Vegas Golden Knights hockey team.

However, Ferreira said the Nevada OPO, which was not being investigated by the committee and allocated 504 organs for transplant in 2020 – enough to qualify it as a top-tier OPO under the new CMS regulations – used the tickets for donor stakeholder relations and development and were purchased through other funding sources, which include donations and other fundraising efforts.

Ferreira told lawmakers during the hearing that the AOPO has recently committed to a campaign that will increase procurement to 50,000 organs annually.

“We are proud of what the OPO community has accomplished,” Ferreira said. “At the same time, we can and will do better.”

References:

https://oversight.house.gov/news/press-releases/oversight-subcommittee-held-bipartisan-hearing-on-needed-reforms-in-organ

www.healio.com/news/nephrology/20201124/cms-finalizes-rule-to-improve-performance-of-organ-procurement-organizations

www.nvdonor.org/house-subcommittee-statement