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<p>The authors aimed for equity, transparency, and efficiency.</p>

Recommendations Target Making Improvements in U.S. Organ Transplant System

By Jonathan Springston, Editor, Relias Media

To alleviate the ongoing shortage and inequitable distribution of supplies, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued recommendations to improve the U.S. organ transplant system.

“There is an opportunity to refocus the organ transplantation system around the patient experience of needing and seeking an organ transplant,” the authors wrote. “Even at its best, the organ transplantation system is not accountable to all patients who need an organ transplant. A shift is needed toward policies that engender accountability to all patients in need of a transplant, whether they are on the waiting list yet or not, as well as organ donors and their families who donate the gift of life.”

The report authors issued 14 recommendations, some of which are targeted to near-term implementation (in the next one or two years) and others that are targeted to long-term implementation (in the next to three to five years). These include creating standardized metrics to track performance and evaluate results; establishing and using a donor care unit for each organ procurement organization; and modernizing the information technology infrastructure and data collection for deceased donor organ procurement, allocation, and distribution. (The full report is available for purchase here.)

The report authors also called on the Department of Health and Human Services to revise the contract with the Organ Procurement and Transplantation Network (OPTN), a public-private partnership that connects the various parties involved in the U.S. donation and transplantation system, “to require or hold the OPTN accountable for taking specific actions.” This contract is up for bid in 2023, so some of the report recommendations might be included in the HHS request for proposal.

The Association of Organ Procurement Organizations issued a statement of support for the report, praising the “data-driven, peer-reviewed scientific research and expert perspectives to determine gaps in the organ donation and transplantation system and comprehensive solutions to foster improvement.”

Meanwhile, there is action happening with federal agencies, some of which seem to mirror certain recommendations issued in the NASEM report. In November 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates the Organ Procurement Organization (OPO) Conditions for Coverage that OPOs must meet to receive Medicare and Medicaid payment. By meeting the requirements of this new rule, CMS believes there could be about 5,600 more organs per year to transplant. Also, the number of annual transplants could rise from about 33,000 to 41,000 by 2026.

The new rule is set to take effect Aug. 1, 2022, and full application and enforcement is set to begin in 2026. When CMS proposed this rule in 2019, it received a warm welcome, and it appears the final version includes much of what was in that first draft.

Building on this, in December 2021, CMS issued a request for information to identify “potential systemwide improvements that would increase organ donations, improve transplants, enhance the quality of care in dialysis facilities, increase access to dialysis services, and advance equity in organ donation and transplantation.”

For more on this and other related subjects, check out the latest issues of Medical Ethics Advisor.