COVID-19 increases importance of implementing reforms to organ donation system

The health care system in the richest country on earth is bending in the midst of a global pandemic because of enormous strain on hospitals and frontline staff.

A critical part of ensuring our frontline workers have the support they need and our most vulnerable patients receive the care they need includes taking intentional and dramatic steps to keep vulnerable populations safely out of the hospital where possible.

For those who already had threatening medical conditions, including the nearly 115,000 Americans waiting for an organ transplant, the pandemic is particularly perilous. And because both African Americans and Hispanic Americans are far more likely to suffer kidney disease than white Americans, this falls disproportionately on minority communities.

I’ve seen this firsthand as a former health professional working in one of the largest emergency rooms in the country.

Some receive the operation they so desperately need. But many patients are not so lucky: 33 Americans die every day in need of a transplant. Awful as this is in any context, in the age of COVID-19, the stakes are only magnified.

The vast majority of patients with organ failure are waiting for kidneys – almost all of whom receive dialysis as a life-sustaining treatment. As a result, more than 140,000 Californians are on dialysis today, meaning more than half a million people in this country are visiting dialysis centers multiple times per week, sitting in close quarters with other patients who are equally susceptible to COVID-19 as they wait for a machine to do what their body cannot.

We need as many people to stay home as possible and we need to take stress off of our hospitals. That is why we need to do all that we can to help more patients with kidney disease.

The Department of Health and Human Services (HHS) is trying to move more patients to at home dialysis, which is a good first step. Though for most dialysis patients, a kidney transplant is the medically preferable outcome; and for taxpayers, because dialysis is enormously expensive and often covered by Medicare, each transplant represents a cost-savings of at least $250,000 per patient.

The obvious question, then, is how do we increase kidney transplants going forward?

Part of the answer is making sure contractors tasked with honoring organ donation wishes, called organ procurement organizations (OPOs), are successfully completing their tasks.

In December, HHS announced a horrifying reality: according to objective data, most of the nation’s OPOs are failing, leaving as many as 28,000 transplantable, lifesaving organs – including 17,000 kidneys – unrecovered every year.

Because African Americans are much less likely to receive a living donor kidney transplant than white Americans – making them more likely to need to rely on the deceased donation system – the brunt of OPO failures is disproportionately borne by minorities, too.

Even before the COVID-19 pandemic, OPO reform received broad bipartisan support. President Obama made organ donation a health care priority in his second term, and President Trump signed an executive order directing OPO reform last July.

In Congress, my Senate colleagues initiated bipartisan oversight over OPOs in February, just before COVID seized national attention. Sens. Charles Grassley (R-Iowa) and Ron Wyden (D-Ore.) posed urgent questions about financial abuse and conflicts of interest at OPOs and their oversight body, the United Network for Organ Sharing (UNOS); and Rep. Katie Porter (D-Calif.) raised similar questions about the Los Angeles OPO, which was later the subject of a Los Angeles Times investigation into seemingly improper tissue recovery practices.

I join my colleagues in asking for answers to these important questions so we can be sure that the system is working effectively for patients. Now, in the age of COVID, given the imminent danger facing patients on dialysis, the health care workers who serve them, and the broader communities that house them, this work is even more urgent than when it first began.

As a former health care worker, it is difficult to see systemic barriers that prevent patients from getting the care that they need. As a policymaker, it is empowering to find a problem with such clear and implementable solutions, and I am committed to fighting to ensure that the government sees these OPO reforms through.

We must do all we can to ensure our system does not break.

Karen Bass is a Democratic congresswoman from California’s 37th District, based in Los Angeles, and the chair of the Congressional Black Caucus.