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Organ Donation: The National Perspective

Organ Procurement Organizations

The 57 Organ Procurement Organizations (OPOs) serving the nation, including Gift of Life Michigan, are community-based non-profit organizations that are designated by the federal government to recover organs from deceased donors for transplantation. They are the only organizations charged with such a responsibility. Since the creation of the OPO structure in the mid-1980s, the U.S. has developed one of the most successful systems of donor identification, authorization, recovery and coordination in the world.

OPOs are critical to the system that tens of thousands of patients depend upon each year to provide life-saving organ transplants. For this reason, it is important to recognize the ongoing, high-level performance of our donation system and to continue to advocate for system changes that support continuous improvement.

A High-Functioning System

Over the past seven years, Organ Procurement Organizations increased annual organ donation by 44% in the United States, a sure sign of a well-functioning donation system continually improving.

US deceased donors chart 2013-2019

During this same time, organ transplants increased substantially, and the number of deaths on the national transplant list trended downward. OPOs commit to maximizing every possible donation opportunity by obtaining authorization for donation, managing the donor, facilitating the organ recovery, and transporting organs to transplant centers.

Wait list removal reasons chart

Recent data in the Journal of the American Medical Association indicates the performance of the U.S. organ procurement system is among the very best in the world, with 43 of the 50 top-performing international jurisdictions – and 9 of the top 10 performers – being U.S. states. Comparing U.S. and Europe data from the Global Observatory on Donation and Transplantation and UNOS demonstrates again the strong performance of the U.S. OPO and transplant system.

US and Europe organ donation comparison chart

Taken together, the data demonstrates great strengths within the current structure of regionally based Organ Procurement Organizations with close cooperative ties to their area transplant centers and donor hospitals.

Donation Continues During a Public Health Crisis

The effectiveness of the Organ Procurement Organization system is highlighted most recently during the ongoing covid-19 pandemic, when OPOs – like many other parts of the health care system –  faced  a multitude of complicating factors that made their work significantly more challenging. Despite more restrictive access to hospital ICUs, fewer in-person meetings with donor families and many other hurdles, the OPO community maintained its world leadership. In fact, where as some nations’ deceased donation cases were cut by upwards of 90%, the United States OPO system experienced a short-term reduction in organ donors of approximately 38% and rebounded quickly to pre-COVID levels. In 2020, 38 of the nation's OPOs experienced an increase in donation over their 2019 total. 

During a different kind of health crisis, that of the ongoing opioid overdose epidemic, OPOs quickly identified the public health implications and worked to create clear clinical pathways for these potential donors and to make the transplant system more open to the use of organs from these donors. As a result, over the last five years, over 6,500 families of overdose victims were able to find solace in donation, and nearly 21,400 transplant recipients received the gift of life. While an increase in donors from overdose was partially responsible for the recent year-over-year increases in donation, it is important to note that non-overdose death donation rates also increased.

Deaths by drug overdose vs non overdose chart

Meeting the Challenge Ahead

With so many patients still awaiting transplant, it is incumbent upon the key stakeholders within the donation and transplant community to align processes of continual improvement and adopt measures that will result in more donation opportunities, additional life-saving transplants and better transplant outcomes. Among the most important are:

Adopt More Accurate and Useful OPO Performance Metrics: Organ Procurement Organization leadership and other donation and transplant advocates are working with the U.S. Department of Health and Human Services to develop more meaningful, independently reported metrics to accurately reflect the performance of OPOs and appropriately adjust for such critical factors as age, cause of death and extenuating circumstances (such as the Covid-19 pandemic). Improved metrics must also be timely and granular enough to inform and promote continuous improvement and increased donation. The new metrics should be free from known data integrity issues, such as those that plague datasets dependent on death certificates.

Promote the Use of Organs from Older and More Complex Donors: Each year, thousands of organs are authorized and recovered by OPOs that are not considered suitable for transplant by current U.S. surgical practice. However, many of these organs are considered suitable for transplant by other nations’ health care systems. Better aligned regulatory incentives across the OPO and transplant system would result in higher use of organs from Donation after Circulatory Death donors, donors of advanced age and donors with more complex co-morbidities.

Expanded Use of Ex Vivo Perfusion and Preservation: Medical advancement in the perfusion, transport and preservation of donor organs have made it possible to expand the pool of donors from which a successful organ recovery and transplant can be made. Working together, transplant centers, OPOs and regulators can continue adoption of these devices and dramatically improve the function of certain donated organs, leading to more and better transplant outcomes.

AOPO 50K by 2026AOPO commits to achieving 50,000 organ transplants by 2026

Members of the Association of Organ Procurement Organizations (AOPO), including Gift of Life Michigan, committed in 2021 to achieving 50,000 annual transplants by 2026. AOPO and its members will work with key stakeholders to achieve this goal by:

  • Expanding Collaboration across its membership
  • Reducing Health Inequities to improve accessibility of organ transplants in minority communities
  • Maximizing Organ Utlitilization
  • Driving Innovation to increase donation

Through collaboration, advocacy and innovation, Gift of Life Michigan will continue to work to improve the OPO system in the U.S., ensuring it will remain among the best transplantion systems in the world.