Earlier this month, the secretary of Health and Human Services, Alex Azar, highlighted that there are hundreds of thousands of people in the United States who face death from organ failure and that many could have a longer, better life if an organ transplant was available.
In Minnesota, over 2,500 people are waiting for a transplant, but fewer than 600 will get an organ from a deceased donor. The gap between organ need and supply remains unacceptable.
When the donation and transplant system was established in the 1980s, few expected that such a large demand for organ transplantation would emerge. Obtaining organs for transplantation is the responsibility of organ procurement organizations (OPOs). They are assigned nonoverlapping geographies and operate noncompetitively. Only approved transplant centers can use these donated organs, and oversight of this system is the responsibility of several federal government agencies.
The Washington Post recently published a series of articles about the country’s organ donation system, suggesting that thousands more patients could receive transplants each year with a more efficient system. Better use of imperfect (but certainly lifesaving) organs can help, such as those from older donors that are used more frequently in other countries than we do in the U.S., but more efficient processes to obtain and use organs is a critical component.
The key point is this: It is certainly possible to “do better” for patients languishing on the organ waiting list. However, it is essential to assess the fundamental question of how efficient the current system is at honoring the generous final wishes of potential organ donors and their next of kin.
The government assesses the adequacy of the organ availability system through self-reporting of potential donors by the OPOs, but the industry itself has said “the accuracy and consistency of that data cannot be assured.” Shouldn’t there be more objective metrics that measure the nation’s organ potential? After all, success or failure is a question of life and death.
It is odd — which is to say, it defies credulity — that from almost 3 million deaths in the country, only 10,000 are found suitable for organ donation, with less than 10 percent of organ donors being over the age of 65. This is in clear distinction to countries in Europe where up to 50 percent of organ donors are over the age of 65.
The Centers for Disease Control and Prevention and state health departments track and codify reasons for deaths. By using such independent information, it may be possible to better estimate the true organ availability and the effectiveness of OPOs that facilitate organ donation. If we are to make progress in getting more organs, objective data are required.
There is nothing magic in the way that organs are identified, retrieved and transplanted, but optimization will require a level of system efficiency and transparency that does not currently exist. Transplant centers are inextricably linked to OPOs — as are the lives of our patients — but we’ve created a system that not only bifurcates organ availability and organ use, but regulation makes it almost impossible to influence, scrutinize or even evaluate the former. Secretary Azar can help fix this.
As a transplant surgeon, it is my job is to save as many of my patients’ lives as possible by transplanting the “gift of life.” But the reality is that today, there are far too few organs recovered to even begin to meet the needs of all the almost 115,000 people on the organ waiting list.
The people working in the nation’s donation and transplantation system are dedicated and idealistic. However, the current gaps in metrics and oversight have failed to identify the necessary efforts that could save thousands of additional lives each year.
Much of the problem has to be fixed from Washington, D.C., and patients deserve action in an area that has long been overlooked. I applaud Sen. Todd Young, R-Ind., for promising to introduce a bill to bring more transparency and accountability into the organ recovery process. It’s a necessary place to start.
Timothy Pruett is a transplant surgeon and professor at the University of Minnesota. He previously served as president of the American Society of Transplant Surgeons and president of the United Network for Organ Sharing.