July 10, 2019
Every day in the United States, Organ Procurement Organizations (OPOs) are entrusted with the incredible task of facilitating organ and tissue donation from deceased donors and their families. At Live On Nebraska, honoring the decisions of Nebraskans to give life to others is not only a great responsibility, but also a privilege we take very seriously.
More than 113,000 Americans are currently waiting for a lifesaving transplant; 20 die each day because an organ is not available to them.
For the past several months, national media outlets, and today, President Trump himself, have brought attention to OPOs, claiming we could do our job better. If we did, they say, more organ transplants would take place each year and less patients would die waiting.
We agree with them.
One of the current central criticisms of OPOs is inconsistencies in self-reported data and how OPO performance is measured.
The Centers for Medicare and Medicaid Services (CMS) established the standard used to monitor OPO performance. Their metric uses “eligible death” criteria to determine if a patient’s death could have resulted in organ donation (potential).
According to this criteria, a death is considered eligible for organ donation if the patient was declared brain dead and 70 years old or younger.
In order to measure performance using this metric, the OPO’s actual number of organ donors is divided by potential donors (as defined by the eligible death criteria).
The formula may sound simple, but the reality is much more complex.
CMS’s eligible death criteria does not account for several other situations that could lead to organ donation opportunities, for instance:
- Patients whose medical status indicates brain death, but who are never declared brain dead according to state law or hospital policy
- Patients over 70 years old (individuals in their 90s have successfully donated organs)
- Patients who are not brain dead, but who are otherwise medically suitable for donation and whose family has decided to end life-sustaining care (this is known as donation after circulatory death or DCD donation).
In addition, individual state and hospital policies dictate how brain death is determined, leading to inconsistencies in the reportable number of patients declared brain dead. And because OPOs are not required to factor potential DCD donors into donation potential, a large opportunity for donation is often missed.
Several years ago, Live On Nebraska’s leadership recognized the flaws in the eligible death criteria and vowed not to measure ourselves by criteria that was “good enough.”
With a growing number of people in need of transplant, we committed to broadening our definition of potential donors and holding ourselves accountable for missed opportunities that other OPOs might not identify or report. Doing so forced us to take a hard look at ourselves, determine where we fell short, and work internally and with our hospital and transplant partners in order to save more lives and help donors and their families turn tragedy into hope.
Since then, Live On Nebraska has continually ranked among the top 15 (of 58) OPOs in the country. We meet weekly with our medical directors to review all patients that met donation criteria and determine successes and failures among them. Our “every organ, every time,” philosophy means that we value the potential of every donor, whether they save one life or eight, and we will do everything in our power to make donation happen, even if we can’t guarantee the outcome.
Based on 2018-19 data, Live On Nebraska ranks 6th in the country for donations from DCD donors. Forty percent of Live On Nebraska’s donations are from DCD donors, compared to 20 percent nationally. Donations from Live On Nebraska’s DCD donors have resulted in 154 transplants in the past five years.
While improving our own policies, practices and outcomes is necessary and rewarding, it’s not enough.
In June, 2018, our President & CEO, Kyle Herber, and Director of Organ & Hospitals Services, John Stallbaum, began conversations with other OPOs in our region to discuss how our success could be replicated and how our industry can implement reporting standards that are consistent and verifiable.
This initiative has since become a priority for the industry and we are proud to be part of the conversation and contributing to efforts that will bring positive changes to all OPOs throughout the country so that our vision — that all in need receive a transplant without waiting — becomes reality.