In a letter signed by ten Members of the U.S. House and Senate, bad science continues to lead the arguments for the Trump OPO rule changes. Two non-peer-reviewed studies by The Bridgespan Group and Bloomworks were done at the behest of Greg Segal’s Organize. 

The studies had a preconceived outcome before they even began. The  “Bridgespan Study,” a vendor-funded, non-peer-reviewed report, serves as the basis or source for numerous articles, Congressional investigatory letters, blog entries, and newspaper stories. Despite being touted as an “independent report.”

It appears that no reporter has even questioned the source or motivations behind the study’s arguments against OPOs.

The primary source of data used in the Bridgespan Study was a much-criticized study, co-authored, unsurprisingly, by Greg Segal and Jenna Arnold (i.e., Organize) and funded by none other than the Laura and John Arnold Foundation.

In short, interconnected private organizations have advanced dubious policy via self -commissioned studies relying primarily on self-referential research in a purposefully opaque manner. They have manufactured the appearance of broad consensus when the source is, in fact, singular. News media has lent these reports’ findings credence. Organize, delivered this package to the Trump Administration, who then drafted destructive regulations based almost solely on one paper and one journal article. 

The result is new regulations that create new draconian metrics for OPOs. This new enforcement system will close one-third of OPOs every four years, based upon adherence to a very flawed metric. This regulation and the associated “investigations” demonstrate a playbook of influencing and the buying of public policy in this country.

Also, Arnold funded a white paper by another consultant, BloomWorks, arguing that private technology interests should play a significant role in the donation system.

Another way to siphon off healthcare dollars and send them to venture capitalists and tech mogul pockets, money that should go into care. 

The flawed metric proposes holding OPOs responsible for whether an organ they recover is transplanted. Transplant centers and doctors decide if an organ is to be used for transplantation, not Organ Procurement Organizations (OPO’s). Yet OPO’s are held accountable by these politicians for everything that can go wrong in the transplant process. It’s as if transplant centers and doctors play no role in deciding what organs are transplanted into often desperate patients.

The letter claims, “These reforms also have urgent implications for health equity, as failures of the current organ donation system disproportionally hurt patients of color.”

Patients of color have been underserved, and this new rule will make that even worse.

President Biden’s Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government mandates exactly the science-based development of public policy that Science in Donation supports. And is particularly relevant to the new Organ Procurement Organization (OPO) rule.  The rule ranks and then closes OPOs based upon metrics that are deliberately blind to the tangible and measurable role that race and underserved status play in the healthcare arena. 

The rule specifies that “We believe that racial characteristics of the Designated Service Area (DSA) should not be a reason for risk-adjusting OPO performance.” This determination to measure performance as if health disparities do not exist was jaw-dropping, especially given the heightened awareness of the structural racism deeply embedded in our healthcare system that our current pandemic exposes.  It begs credulity that federal regulations were drafted that utterly discounts the role racial and ethnic demographics play in health care delivery.

The letter states: “Reforming the US transplant system is a bipartisan issue.”

We agree that reforming the transplant system should be both bipartisan AND informed, with the best science and standards available.  At Science in Donation we support reform of OPO metrics and transplant center accountability, but those issues are missing in the Trump rule changes. The Trump rule does not propose “reform” but rather decimation.  The wholesale closure and disruption mandated by the rule will bring chaos to a complex system that should be supported and improved, with bipartisan input and the resolve to save lives.