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POGO Becomes PAY GO

By Science In Donation

Adam Zagorin’s latest piece of propaganda in support of new organ donation rules castigates the non-profits charged by congress to recover organs in the United States. 

His piece published on the Project on Government Oversight (POGO) website recklessly draws false conclusions.  We do not know if ignorance, misguidedness, or profit motivated Mr. Zagorin’s rant. We at Science in Donation would like to call out the falsities in the POGO piece.

1. The group of hedge-funded think tanks behind the new destabilizing OPO rule has little concern for the donor families who are the source of all transplantable organs.  Mr. Zagorin calls those who have campaigned for the new organ donation rule “patient advocates.”

However, generous donor families are never mentioned in the discussion about OPO performance. The conflict here is not between newly minted “patient advocates” and OPOS but rather between moneyed special interests and sound and deliberate public policy.

Forcing OPO’s into a “Hunger Games” competition will not benefit either the patients on the waiting list to receive an organ or families who have donated their loved one’s organs.  Competition between OPOs will bring chaos and disruption.

2. Mr. Zagorin rails against OPO expenditures opposing the new rule. He fails to mention the OPO’s responsibility to protect their mission and their public charge. OPOs and their trade organization are the targets of a well-financed, painstakingly coordinated, and shockingly effective assault on their very existence. It is easy to identify the assault and private funding sources through 990s and lobbying reports. M. Zagorin attacks healthcare organizations’ attempts to communicate with their elected representatives to defend their mission and patients. He neglects to report on or even mention the well-documented tactics utilized by the Arnold Foundation, Organize, and others to influence public policy.

A journalist might ask, how did POGO, the Washington Post, and Kaiser Health News hear about this issue? How many contacts has POGO (or any of the real news organizations cited above) had in the last year with representatives of Organize, Arnold Ventures, or any person or entity funded by them? 

Other than Kaiser (which has an Organize board member on staff in a related entity) and POGO, have any of the other entities received financial support or job offers from Arnold Ventures’ associated entities? 

If you can’t answer those questions quickly, imagine what it would be like if we asked you ten others like it, going back decades, and threatened you with congressional action if you failed to respond? Feel the need to hire a lawyer yet?

3. Rather than summarize the content of and impact of the regulation, which is at the heart of this controversy, Mr. Zagorin calls the regulation “transformative.” If one calls mandatory closure of up to a third of the industry during each four-year cycle “transformative,” well, sure. Others might call it “destructive.” As for the new regulation’s “legal enforceability,” an unbiased reporter might ask how the preceding rules were somehow “less enforceable,” given that they too had performance metrics, the power to close, and the force of law.

What would make a real story?: Compare the actual, documented cost and impact of the draconian competition, merger, takeover, and closure of an OPO? We have recent and historical examples of how improvement measures and strengthening general best practices save money and work.

4. Mr. Zagorin describes a real problem, racial inequity in healthcare and access to organ transplantation. He then somehow finds a way to blame OPOs for that, too. Read his paragraphs on racial equity. He says, in essence, that someone once accused OPOs of racial profiling, which, given what OPOs do, would mean that they do not reach out to communities of color or pursue donations from decedents of color. But how can this be, given that OPOs are mandated to assess and evaluate all potential donors in their service area?

Existing law mandates that every decedent in a hospital be referred, a hospital responsibility, and the facts around these referrals are readily ascertainable from existing data. Current law requires that every medically suitable donor be followed up (an OPO responsibility, the performance of which is also readily ascertained from available data). 

If people of color are not being approached to make a gift, it is either because hospitals are not referring them or OPOs fail to respond. Data demonstrating these facts is not cited in Mr. Zagorins article, nor any of its cited sources. It would appear that the basis of the random accusations of racial profiling arises from one Arnold Foundation-funded report, which quotes one ex-employee of an OPO. 

“He said, she said,” is an unacceptable basis for donation policy, especially in the face of accurate data, which is likely to suggest that the reasons for the disparity in transplant come from difference in access, funding, education, and transplant center policies. 

In the actual rule, data concerning race is deemed irrelevant and not to be considered.

In an impartial piece of journalism, THAT would be the story. An unbiased reporter would say, “ Data, please. We can’t fix it until we see it. Show me.” The real story would explore, “Is there a disparity in the referral of deceased donors from communities of color, and in the response rate of OPOS to those donors? Are there some OPOs whose work with those communities leads to more donors from those communities? If so, can those practices be rewarded and replicated?”

5. “Coziness is nothing new, even—or especially—at the top of national politics. But attempts at influence-peddling and special access spotlight the public’s worst fears—the search for friends in high places who can be called upon to protect the interests of the powerful, the connected, and, sometimes, the misguided.”

A reader could be forgiven for thinking the POGO quote above was about Organize and their tactics to influence public policy. Anyone who has spoken to co-founders  Jenna Arnold or Greg Segal for longer than 8 minutes over the last ten years will recall their frequent mentions of political connections, including to the Obama administration, a former HHS Chief Technology Officer (who sits on the Organize Board). 

Calling any OPO executive “powerful” and “connected” is laughable compared to the people and the money behind the new rule.1

Science in Donation asks its readers, members of the public, and, most importantly, policymakers to think critically. We believe organs like the public trust are too precious to be bought and sold.

1 We do not opine on the reality or propriety of these claimed connections, only that they have been claimed loudly and often, and the sudden anointment of these two individuals’ company, both with no professional  background in organ donation or transplant, to the position of Innovator in Residence to CMS in 2017 lends some credence to their claims)