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Here’s How Organ Donation Reform Could Save Thousands of Lives, Billions in Tax Dollars

BY Adam Brandon and Andy Slavitt
12/11/2019
Originally Published in USA Today by Adam Brandon and Andy Slavitt on 12/11/19.

It might seem Republicans and Democrats do not agree on much in health care, but reform for organ donation is one of the issues that has found bipartisan support.

Inefficiencies in our health care system have let down patients and families across the nation. Unfortunately, the American system of organ donation has been especially susceptible to waste when it comes to taxpayer resources. While 95% of Americans support organ donation, the number of people on organ waiting lists continues to outpace the number of organs available for transplant.

For low-income people and communities of color, the disparities in deceased and living donation are even greater. These populations face higher rates of chronic diseases that lead to kidney, heart and liver failure, among others. We can’t accept these outcomes, yet the system we’ve been saddled with leads to tens of thousands of unnecessary deaths and costs taxpayers billions each year.

Roughly 113,000 Americans are waitlisted for organ transplants, and 1,000 patients die every month for lack of an organ. The reason, though, is not because there aren’t enough people willing to donate. Rather, it is a broken system of government-granted monopoly contractors called organ procurement organizations (OPOs) that have lacked accountability for decades.

When someone dies in a way that makes them medically eligible for donation (such as strokes or opioid overdoses) OPOs are charged with showing up at the hospital and working with the surviving family to coordinate a potential donation.

Transplant system is grossly inefficient

But research shows that OPOs are grossly inefficient, and that up to 28,000 organs go unrecovered from potential donors each year. In some states, including New York, California, Oregon and Virginia, OPOs collect organs from only 1 out of 3 eligible donors. In others, such as Kentucky and South Carolina, this number is as low as 1 in 4. For a nation as advanced as the United States, this is unacceptable.

Incompetence is not even the whole story. Investigative reporting and government audits have documented a culture of waste, fraud and abuse. In Los Angeles, the local OPO has been cited by the Office of the Inspector General for misusing taxpayer dollars. In Alabama, two OPO executives went to federal prison for running a kickback scheme to defraud taxpayers out of millions of dollars.

Perhaps most upsetting is just how willing policymakers have been to tolerate it. Despite gross underperformance, as well as this highly troubling financial impropriety, no OPO has lost a contract in decades. In fact, since the Government Accountability Office first produced a report about OPO problems in 1998, more than 200,000 patients have died waiting for transplants, largely as a direct result of government inaction.

Bipartisan support for reform

Thankfully, a bipartisan group of lawmakers is working to change course. Sens. Todd Young, R-Ind., and Michael Bennet, D-Colo., have introduced a bill to apply much-needed accountability metrics to OPOs across America, and 74 members of Congress recently wrote a letter in support of new OPO metrics.

Additionally, the Trump administration issued an executive order directing the secretary of Health and Human Services to issue a rule to drive more transparency for OPOs, which has met with broad support — including from senior members of the Obama administration. That rule could come anytime now, and patients need it to be as strong as possible.

Much of the bipartisan support results from the coupling of the reforms’ lifesaving and cost-saving potential. Because most patients in need of kidney transplants are placed on dialysis while they are waiting for a kidney to become available, dialysis now costs Medicare more than $35 billion annually — a full 1% of the federal budget.

Simply by increasing the number of kidney transplants, however — which is also the best medical outcome for those patients — taxpayers could save up to $12 billion in just five years through avoided dialysis costs.

The solution starts with objective standards for evaluating OPOs, and with the government taking strong action to decertify OPOs not serving patients or taxpayer interests. With costs to human life and the Treasury this staggering, there’s no reason that Congress and the Trump administration can’t follow through and make these changes now. Patients simply can’t afford to wait any longer.

Andy Slavitt, chair of United States of Care, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Adam Brandon is president of FreedomWorks, a grassroots service center for activists who support smaller government, lower taxes, free markets, personal liberty and rule of law.