CHAPTER 7: Organ Donation Shortage: A Public Health Perspective

ORGAN DONATION UNITED STATES STATISTICS

• Over 107,000 men, women, and children are on the national transplant waiting list as of February 2021, and every 9 minutes another person is added.¹

• Although 90% U.S. adults support organ donation, only 60% are registered as donors.¹

• Only 3 in 1,000 people die in a way that allows for organ donation.¹

• On average, 17 people die daily due to shortage of organs available for transplant.²

CURRENT U.S. ORGAN DONATION PROCESS AND POLICY

• The United States has an opt-in organ donation policy, in which organs are procured from individuals who provide an explicit consent to donate.³

• Other nations, such as Italy, have an opt-out policy, in which consent is presumed and organs are procured from all individuals, unless there is consent not to donate.⁴ Currently there are mixed study results for the relationship between the two consent systems and organ donation rates.^3–6

• Potential donor is defined as deceased individual from whom at least one vascularized organ (heart, liver, lung, kidney, pancreas, or intestine) can be transplanted.⁷

• Entities involved in the donation process:

  • Donor Hospital: After a patient has died or nearing death, the hospital will contact the state’s Organ Procurement Organization (OPO), and provides patient information to confirm if patient is eligible for organ donation. Medical providers do not have access to donor registry or waiting list.

  • Organ Procurement Organizations: Non-profit organizations, evaluated by Centers for Medicare and Medicaid Services (CMS), are responsible for coordinating the process of organ donation in each of the designated Donation Service Areas.⁷

  • If the OPO determines the patient is a potential donor, then a representative travels onsite to begin the procurement process.⁸

  • Transplant Center Team: Includes clinical transplant coordinators; social workers; financial counselors; transplant physicians, who only manage the patients’ medical care, tests and medications; and transplant surgeons who perform the transplantation surgery.⁹

• Currently, transplant programs determine suitability of potential transplant candidates based on criteria developed by each program.¹⁰

• There are currently 57 OPOs in the U.S., and each has an assigned donation service area (DSA).

• OPOs are evaluated and recertified by CMS every 4 years based on “Conditions for Coverage,” using two self-reported metrics:

  • Donation rate ratio: actual organ donors/eligible deaths.

  • Observed to Expected organ yield: based on number of organs transplanted per actual donor.⁷

• The Scientific Registry of Transplant Recipients (SRTR) reports on transplant programs and OPOs. The reports include information about the candidates on the transplant waiting lists, outcomes on the waiting list, transplant recipients, the donors, and the outcomes after transplant.¹⁴

• Approximately 250 transplant centers are members of the Organ Procurement and Transplantation Network (OPTN).

• Organs are matched to recipients based on information like blood type, body size, and tissue. Recipients are found on a national waiting list operated by the United Network for Organ Sharing (UNOS).¹¹