NEDS is concerned that national NPR aired a segment on April 13, 2024 (“Patients die every day waiting for organ transplants. The problem isn’t a lack of donations”) which included a number of false, misleading and unsupported statements. In this segment, NPR only interviewed Jennifer Erickson, who is paid by an advocacy group highly critical of OPOs that successfully lobbied to rewrite federal law to allow for-profits to run the national transplant system. NPR did not provide a countervailing viewpoint from any professional that actually works in organ donation and transplantation.
Here are some of the false and misleading statements that must be corrected.
1. In response to the question “how do these organs end up in the trash” Erickson replies “there was a surgeon who testified before the Senate about receiving a kidney in a box with tire marks on it.”
FALSE AND MISLEADING – A surgeon testified that a kidney was delivered to her program in a box that had tire marks. However, organs are packaged to ensure the organ is well-protected during transit and in fact, it is NEDS’ understanding that in the case identified by this surgeon, that kidney was successfully transplanted. Erickson fails to mention this fact. The case Erickson referenced is not an example of how an organ “ends up in the trash” but instead is an example of an organ being transplanted despite alleged transportation issues (that were never verified).
It is important to note however that transplant surgeons can and do turn down organs OPOs recover and offer for transplant into their patients. Last year alone, more than 8,500 kidneys were recovered by OPOs, ultimately declined by transplant centers and went unused – leading to a record high kidney non-utilization rate of 28%. This is one of the biggest problems the system faces and although not mentioned or explored in the segment, ties directly to NPR’s lead-off of its story regarding allegations about Memorial Hermann in Houston: transplant program decisions and not OPOs determine whether organs that are available are actually transplanted into waiting patients.
In 2023 NEDS recovered and offered 225 kidneys that were turned down and ultimately not used (approximately 22% of the total kidneys NEDS recovered). NEDS made 1,234,210 offers to transplant programs for their listed patients in an attempt to place those 225 kidneys, all of which were rejected.
2. Erickson states “Organs can be recovered by people with no clinical experience. I mean Scott, you could be recovering organs tomorrow. You’re a great radio interviewer but I’m sure you would agree that we should actually have clinicians doing that work. And, that isn’t actually what the federal government requires.”
FALSE – There are specific federal regulations as well as national hospital accreditation standards that require OPOs to ensure that only qualified and trained clinical professionals recover organs. There are also applicable standards of practice endorsed by medical professional societies (including for example the American Society of Transplant Surgeons).
3. Erickson states that “the central flaw” in the system is that it is set up as “monopolies” and that every OPO that received a contract in the 1980s still holds a contract today “and has never once faced accountability….Tax payers send them a check and they do not have to be accountable for the job they actually do.”
FALSE AND MISLEADING – There are federal regulatory performance standards for OPOs that have been in effect for decades and OPOs are held accountable to those standards as well as other regulatory criteria which OPOs are audited to (in unannounced surveys just like hospitals) and recertified every 4 years. The fact that no OPO has been decertified does not demonstrate a lack of accountability. In the past 10 years alone, OPOs have doubled the number of deceased organ donors in the U.S. – a fact completely missing from this segment.
Moreover, it is incorrect to state that every OPO that received a contract in the 1980s still holds a contract today. There were 127 OPOs when the system was first founded and there are only 56 today. Over time, lower performing OPOs and those with smaller service areas have been combined with higher-performing or larger OPOs. With the approval of CMS, voluntary consolidation rather than decertification has served to effectively drive performance improvement to prevent disruption of lifesaving services to patients.
NEDS is a great example of such voluntary OPO consolidation with the creation of NEDS in 2017 for the affiliation and eventual merger of LifeChoice Donor Services (CTOP) into New England Organ Bank (MAOB) in 2021. In the first 3 years after NEDS was formed, NEDS doubled the number of organs transplanted from donors in the smaller OPO service area (CTOP) and a $3M cost savings was realized to CMS in lowered kidney fees.
4. When asked if OPOs have a “financial incentive” to “show up and talk to families about organ donation” Erickson says “they actually don’t….They are not funded based on how many organs they recover or on how many organs are successfully transplanted. They’re just refunded for whatever they spend.”
FALSE AND MISLEADING. OPOs are financially incentivized – aligned with their mission and with regulatory performance standards – to aggressively pursue every possible organ donation opportunity. OPOs are in fact reimbursed by transplant programs for organs that are successfully transplanted. OPOs are cost-reimbursed by the federal government for expenses related to kidney donation only. This reimbursement to OPOs by the federal government does not cover the costs of any of the other organ donation activity – hearts, lungs, livers etc. Furthermore, even for kidney-related costs, OPOs are not refunded “for whatever they spend” as stated by Erickson. Rather, CMS defines “allowable costs” related to kidney donation. OPOs are required to comply with this standard and are subject to financial audits by CMS annually.
5. Erickson claims that how OPOs are reimbursed “is completely divorced from how they actually serve patients.”
FALSE. As described above, OPOs are reimbursed directly aligned with how they serve patients – the donor and donor families as well as organ transplant recipients. Erickson seems to suggest OPOs only serve transplant patients. It is incredibly important to recognize that OPOs serve donors and donor families and to never lose sight of the fact that these individuals make transplant possible in the first place.
6. Erickson states “74%” of the OPOs are “failing performance standards.”
MISLEADING. Erickson fails to mention that the new federal performance standards for OPOs set the performance threshold arbitrarily as the top 25th%. Accordingly, if performance is set as the top 25th%, it would be expected that approximately 75% will be under that threshold regardless of performance. CMS does not use the term “failing” for OPOs that are under the top 25th%. And with good reason, OPOs have produced 13 years of consecutive year over year records for deceased organ donation, demonstrating tremendous performance improvement and growth.