Government, industry look for new ways to meet organ shortage
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In March, a news story on the home page of the website for Sierra Donor Services was titled “The struggle is renal.” It is a tease on the word “real” because 89% of those waiting for an organ in California are in need of a kidney.
That is a key focus for Sean Van Slyck, MPA, CEO of Sierra Donor Services, a Sacramento, California-based organ procurement organization (OPO) that serves 13 counties. The OPO, one of four in the state, has a diverse service area population of 2.7 million people. Last year, the OPO procured 496 organs.
Source: Gift of Life Donor Program
“The counties have large communities with Hispanic-Latino, Asian-Pacific and African American residents,” Van Slyck, who has worked in the organ procurement specialty since 1998 and as the CEO of Sierra Donor Services for the past 3 years, told Healio/Nephrology News & Issues. “But we have been able to double our donor numbers by making connections in the community – providing more resources in underserved areas, building key relationships with groups, like the Black Nurses Association, and reaching out to the Hispanic community.”
Incentives
Health equity issues have been a challenge for the organ transplant community. In 1991, an Office of Inspector General (OIG) report concluded distribution of organs for donation was not equitable.
“The access of patients to donated organs remains unequal in some important respects,” OIG Inspector General Richard P. Kusserow wrote in the report entitled “The distribution of organs for transplantation: Expectations and practices.”
CMS is now providing health equity incentives in its ESRD Treatment Choices model to encourage more referrals for patients from underserved areas to get evaluated for transplantation. Dialysis clinics that demonstrate significant improvement in rates of transplantation among beneficiaries who are dual-eligible for Medicare and Medicaid or low-income-subsidy recipients could earn additional improvement points in the program and receive incentive payments.
The Association of Organ Procurement Organizations (AOPO) is also working with a consortium of historically Black colleges and university medical schools to launch four pilot programs aimed at improving donation and transplantation among Black patients. “The program’s aim is to diversify the transplant workforce and broaden outreach to minority communities,” according to a press release from the AOPO. The pilot programs have been launched in Los Angeles, Washington, D.C., Nashville and Atlanta.
OPO performance
Reaching out to underserved populations to improve organ donation and transplantation comes at a time when OPO efforts to procure organs is being scrutinized. More than 103,800 patients are waiting for an organ transplant in the United States, of which 88,656 are for kidneys, according to the latest data from the United Network for Organ Sharing (UNOS). But organ procurement – and the number of transplants – has been growing. According to the most current data from UNOS, there were 42,889 organ transplants in 2022, 36,421 of which were from deceased organ donors. Last year, 14,905 people became deceased organ donors nationwide, marking the 12th year in a row for increases in deceased donation (see Table for five largest OPOs). It was also the tenth consecutive year for increased organ donor transplants.
In terms of OPO performance, UNOS data shows 73.6% of OPOs reported donor recovery increases over their 2021 numbers, with two-thirds of OPOs setting records for donors recovered in a single year.
HRSA initiative
In April, the Healthcare Resources and Services Administration (HRSA) released a list of initiatives aimed at addressing OPO performance. As previously reported by Healio, HRSA plans to introduce contract solicitations for multiple awards to manage and improve the Organ Procurement and Transplant Network. The initiative would also focus on modernizing the information technology infrastructure, installing an OPTN board of directors independent of the contractor and develop a public dashboard of key measures.
“UNOS supports HRSA’s plan to introduce additional reforms into the nation’s organ donation and transplantation system while increasing accountability, equity, transparency and oversight,” Maureen McBride, interim CEO of UNOS, said in a statement in response to the HRSA initiative.
Jan Finn, RN, MSN, president and CEO at Midwest Transplant Network (MTN), has been successful at not only serving the residents in her service area of 5.6 million people, covering the state of Kansas and parts of Missouri, but has also sent organs to other parts of the country. “I don’t think the changes proposed by HRSA and those by UNOS would necessarily be the driving force to improve our donation numbers,” Finn told Healio/Nephrology News & Issues. “I believe key initiatives that are internally driven impact our own processes and own culture,” she said.
Under Finn’s leadership, MTN procured 498 deceased donor kidneys in 2022 and provided 972 organs for transplantation.
‘Giving community’
Richard Hasz Jr., MFS, CPTC, manages one of the oldest and most successful OPOs in the United States. The president and CEO of Philadelphia-based Gift of Life Donor Program started as a transplant coordinator for the organization in 1993, and recently took over the OPO as the CEO.
His staff covers an area of 11.4 million residents in eastern Pennsylvania, southern New Jersey and Delaware.
In 2022, Gift of Life coordinated the most organ donors – 690 – and the most organs for transplant in the country, resulting in 1,744 transplants, the most of any OPO in the United States in 2022, according to a press release.
“The environment we are working in is not an easy one,” Hasz told Healio/Nephrology News & Issues. “We are tasked with asking families to donate an organ at the worst possible time.
“There is no ‘magic bullet’ in procuring organs,” Hasz said. “We have to make sure we are not missing any opportunities.”
Discard rates
One of the main criticisms of organ procurement and transplantation is the number of “discards” of kidneys and other organs that are deemed unsuitable for transplantation.
“Some of that has to be expected,” Hasz said. “Sometimes we procure organs from medically complex donors that may not benefit patients. We need to work with our transplant center partners and match the complex organs with a center and recipient that is willing to accept the organ.”
Van Slyck agrees that partnership with transplant centers is important. “The organ discard rate is one of the most pressing challenges that our field must overcome,” Van Slyck told Healio/Nephrology News & Issues. “It will take efforts not only by OPOs but also by the transplant centers who ultimately control the decision of whether or not to accept a recovered and matched organ on behalf of their patients.”
Hasz and Finn both agree that organ transport needs to improve, especially when demand outside a service area of an OPO increases. “I’ve heard from surgeons before, ‘If you called me 12 hours ago, I could have used [the organ],’” Hasz said. “That is an area in need of improvement.”
- References:
- HBCU medical schools and organ procurement organizations launch pilot programs to increase organ donation and transplant among Black Americans. https://aopo.org/hbcu-medical-schools-and-organ-procurement-organizations-launch-pilot-programs-to-increase-organ-donation-and-transplant-among-black-americans/. Published April 5, 2023. Accessed April 24, 2023.
- 2022 organ transplants again set annual records. https://unos.org/news/2022-organ-transplants-again-set-annual-records. Published Jan. 10, 2023. Accessed April 24, 2023.
- www.healio.com/news/nephrology/20210709/cms-proposes-changes-to-esrd-treatment-choices-model-to-improve-equity-of-care
- www.healio.com/news/nephrology/20230323/new-federal-initiative-aimed-at-revamping-organ-procurement-system.
- For more information:
- Jan Finn, RN, MSN, can be reached at jfinn@mwtn.org.
- Richard Hasz Jr., MFS, CPTC, can be reached at rhasz@donors1.org.
- Sean Van Slyck, MPA, can be reached at sean.vanslyck@dcids.org.
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