Rethinking the way America hands out organs

MARY REICHARD, HOST: Coming up next on The World and Everything in It: Organ donations.

MEGAN BASHAM, HOST: But before we get to that, Mary, we need to put out a call for more pre-rolls.

REICHARD: Oh, right! We’re running low. Pre-rolls are how we start the program. You know, “Hi, my name is Mary and I co-host a podcast. I live in Missouri and I hope you enjoy today’s program.” That’s the basic script, but you can get more creative if you want.

BASHAM: Creative, like the woman who recorded from the Antarctic with penguins in the background! Now, some parameters do apply: no longer than 20 seconds. No plugs for your business; just keep it generic like “physician” or “commercial airplane pilot” without mentioning the hospital or airline.

REICHARD: Right. It’s not hard to do and we love to hear your voices. You can find instructions at worldandeverything.org. Hover over the “engage” tab, then click “record a pre-roll.” It’ll explain how to record on your phone and then upload it to us.

BASHAM: Worldandeverything.org, engage tab, then record a preroll. OK, got it. 

Back to our original topic: organ donation in the United States. At least one hundred twenty thousand Americans are waiting for some type of organ transplant. Most of them need a kidney. Others are waiting for a heart or liver.

REICHARD: All of this requires meticulous coordination. Fifty-eight organizations match available organs with recipients on the waiting list. These organizations are called Organ Procurement Organizations—or OPOs. And they’ve been criticized for letting organs go to waste or missing donation opportunities. 

Now, industry leaders are pushing for a change. Here’s WORLD Radio’s Anna Johansen with the story.

PATENAUDE: We thought she was pretty healthy. She was a pretty healthy 67 year old woman. 

ANNA JOHANSEN, REPORTER: This is Heather Patenaude. About four months ago, her mom suffered a massive heart attack. 

PATENAUDE: She was in ICU for a couple of days, but she had been without any oxygen for about 50 minutes. So we knew that she probably wasn’t going to survive. 

Doctors declared her brain dead. That was when someone approached Heather Patenaude and her family about organ donation.

PATENAUDE: Because my mom was declared brain dead, but her body, her heart obviously was still beating, they were able to bring in the organ donor organization that we worked with. We worked with an organization called the Gift of Hope. 

Gift of Hope is an OPO in Illinois. It matched Heather Patenaude’s mom with a recipient in the Chicago area who needed a liver. She was one of 450 cases Gift of Hope oversaw in 2019.

Each OPO tracks how many potential donors they have, how many organs they recover, and how many successful transplants they coordinate. 

Not every potential donor leads to a successful transplant. But critics think more of them should.

According to a 2017 analysis, OPOs could be recovering 28,000 more organs per year. Now, the government is proposing new standards to make OPOs come closer to reaching that number.

So how do OPO’s measure success?

First, they tally the number of eligible deaths—those that occur under the very specific circumstances that allow for donation. Then, they compare that to the number of organs actually transplanted. 

The problem lies in the difference between those two numbers.

KEVIN O’CONNOR: The issue is around the reporting of the number of opportunities, the potential donors. 

Kevin O’Connor is the CEO of LifeCenter Northwest, an OPO in Washington state. He says there is a standard definition for who is and is not a potential donor. But it’s an academic definition. And each OPO interprets it differently.

O’CONNOR: The specific criteria, medical criteria, and the definition of an eligible, uh, donor or eligible death, uh, allow for some subjectivity and interpretation.  You know, one, one organization might consider somebody to be medically unsuitable, uh, where another might consider them to be at least worth pursuing to see whether or not there’s some interest on the transplant side. 

That’s where the new metric comes in. The government is proposing that all OPOs be held to a universal standard. They would have to meet the donation and transplant rates of the peak performing OPOs—the top 25 percent. Every year, the government would assess the OPOs to make sure they’re performing up to snuff. If not, they could get decertified.

But recovering more organs doesn’t mean they’ll end up saving someone else’s life.

Kevin Cmunt is the CEO of Gift of Hope. He says OPOs aren’t the problem. Instead, too many transplant surgeons reject available organs. 

CMUNT: We’ve gone through the whole process. We’ve gone to an OR, we removed the organs and now somebody has decided that they’re not going to use them. 

Surgeons get graded on how well the organs do after they’re transplanted. So they’re very picky about which organs they accept. They don’t want to transplant less-than-perfect organs, so those often get discarded. 

CMUNT: There’s 5,000 of those a year that get discarded.

Cmunt says the proposed changes to the metric wouldn’t fix that problem. 

He also points out that OPOs have different resources and face different circumstances.

CMUNT: There’s a lot of things that are outside the control of an OPO that might make a patient here in Chicago a potential donor, but maybe in rural Wyoming not.

Chicago has a lot of transplant surgeons. Cmunt says he can send a team to wait at a hospital just in case a patient’s heart stops and he or she becomes a donor. An OPO in rural Wyoming doesn’t have that luxury. Logistics make a big difference, so Cmunt says OPOs shouldn’t all be held to one standard.

Kevin O’Connor agrees that all OPOs are different…but he’s still in favor of the proposed changes.

O’CONNOR: I would say that there’s definitely room for improvement in terms of having more independently reported, standardized, verifiable…data…throughout the country.

For WORLD Radio, I’m Anna Johansen reporting from Itasca, Illinois.

(Photo/Creative Commons, Flickr)

WORLD Radio transcripts are created on a rush deadline. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of WORLD Radio programming is the audio record.