Organ procurement organizations do not make transplant decisions but we do help save lives

Written by David DeStefano

The U.S. organ donation and transplantation system has recently been embroiled in conflict and controversy. Recently implemented rules by the Department of Health and Human Services (HHS) and recent media coverage questioning organ procurement practices are threatening donation and the gift of life.

I ask that the new class of Congress, the new Administration, and the media first seek to better understand donation and the work OPOs and nonprofits do in this space.

The media’s constant scrutiny of OPOs is leading to fear and the spread of misinformation about the organ procurement process. Compiled with the new HHS rules prioritizing metrics over mission, OPOs are now being cast in a shadow that is threatening our charge – to facilitate the gift of life.

It is important that we acknowledge the remarkable success of our current system, while focusing on thoughtful, measurable and meaningful improvements. In 2023, 46,632 transplants were performed from both living and deceased donors. A gift from just one organ donor hero can save up to eight lives and improve the lives of up to 75 others through tissue donation.

Any policy changes must first recognize that the role of an OPO is to facilitate the gift of life and advocate for donation with our professional partners – our community, our hospitals and transplant centers, our coroners and medical examiners and, most importantly, our donor families. While OPOs are responsible for donation, we collaborate with but don’t control these partners.

Policymakers must recognize that hospitals are where the rare possibility of donation occurs and help OPOs support and facilitate donation processes for interested families.

Transplant centers are responsible for the care of transplant patients, acceptance of gifted organs, and are vested with the medical decision of whether or not to transplant. OPOs are entrusted with ensuring a compassionate and inspiring donation conversation, where we connect with our donor families during a profoundly sensitive and intimate time. Any changes must recognize and prioritize this moment to ensure every family has the right to a donation conversation that is respectful of their loved one, free from additional pressures, and worthy of their gift.

Although an OPO’s overall performance is measured by the Centers for Medicare and Medicaid, these measures are tied to proficiency and excellence in successful procurements and transplants. OPOs do not receive financial incentives based on the number of organs recovered. Under the structured rules, OPOs will be judged by the number of donors facilitated and the number of organs transplanted. This is where I am most concerned and where I believe false narratives have taken root. OPOs do not make transplant decisions and should not force donation decisions.

OPOs should passionately advocate for donation, and these regulations should support and measure an OPO’s response to any true donation opportunity and an effective and compassionate donation conversation – and not simply require “more.” Instead, the current regulations are a catalyst for competition in donation, where they should support – and require – more collaboration among these donation partners. The regulations should establish shared accountability standards for these life-saving outcomes.
As someone deeply dedicated to the service of this mission, we must never lose sight of the individuality of each donor – that there is a life lost and a family in grief.

DeStefano currently serves as President and CEO at We Are Sharing Hope SC (SHSC) in Charleston, South Carolina.