Shortsighted CMS rule change could endanger our organ transplant system

Imagine a plan to improve a health care provider system that calls for shuttering 75 percent of its hospitals — with no backup plan for shifting patient care elsewhere. It would be disastrous, especially for patients. 

In essence, that’s what a proposed CMS rule governing our nation’s organ donation system entails: the change punitively targets the national network of 58 federally-funded, nonprofit Organ Procurement Organizations (OPOs) that orchestrate the complex, highly sensitive process of matching donors with viable organs for transplant to the most appropriate recipients. 

If the rule goes into effect, up to 75 percent of these community-based OPOs, the linchpin of a transplant system acknowledged to be the best in the world, could face decertification. Yet CMS is not providing for a structured improvement agreement, appeals process, or alternative to coordinating donations and transplants in the communities that lose their OPO. It would be disastrous, especially for patients.

As a transplant surgeon who relies on OPOs to save lives, I am deeply concerned. We all should be. The proposed CMS rule change, predicated on inaccurate data, demonstrates an alarming misunderstanding of the highly interdependent nature of the process — a process in which success happens collectively and improvements must be addressed collectively. 

Every life saved by organ transplant represents the successful execution of carefully choreographed steps involving the cooperation of numerous parties, including OPOs, donor hospitals, transplant hospitals, medical examiners, and donor families across the nation. Every party and every step of the process is critical. Altering just one part — as the CMS rule would do — is extremely shortsighted and unnecessary. 

Yes, our organ donation system can and should improve. This is true of any system, particularly in health care, where lives are at stake. And as someone who works everyday within the heart of our transplant system, I can attest that every facet of this system — not just one — needs improving. 

For example, the proposed CMS rule holds OPOs accountable for instances in which suitable organs are not used for transplant. This fails to acknowledge or grasp that transplant centers have incentives that work against accepting every organ offered by the OPOs. 

It fails to acknowledge that, despite its imperfections, the U.S organ donation system is ranked the best in the world, with nearly twice the number of transplants annually than in Europe. Or that the system has recorded steady improvements over the last decade, such as improved equity in access to transplant for waitlisted patients and faster real-time communications to facilitate the organ offer process.

These improvements have been instigated from within the system, where the high stakes and complexities of change are fully understood. No one is more invested in improving the system than these individuals and organizations working to save more lives every day. It is wrenching work —physically, mentally, and emotionally — to navigate one family’s tragedy for another’s blessing, always racing against the clock. It is work driven by calling, not monopolistic greed, as some who are advocating for the CMS rule change would have us believe. 

But there is more to do. We need to improve systems for rapid information sharing, we need to implement better technology to improve timeframes for transplants, and we need to enhance communication throughout our community. The way to do this is cooperatively and collectively. 

Our country’s unsurpassed organ donation and transplant system is holistic and must be reviewed and improved as such. We cannot disrupt a single component of it — especially one as integral as the OPO network — and assume this will lead to improvement. Instead, we must implement system-wide reforms based on accurate data to drive enduring positive change, to make the best even better. 

Herein lies the true opportunity: we have a once-in-a-generation chance to create an organ donation system like none other in the world — driven by innovation, moving like clockwork, employing the latest technologies, and utilizing available organs at the highest possible capacity. We must seize it — with eyes open to all the issues and considered measures to resolve them.

Dr. David Mulligan is a professor and chair at the Division of Transplantation and Immunology at Yale-New Haven Health Transplantation Center. He is the president of the Organ Procurement and Transplantation Network/United Network for Organ Sharing board.