Federal Organ Donor ‘Reforms’ Are Counterproductive

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ed. note Distinguished Emeritus Professor of Surgery Dr. Christoper Johnson at the Medical College of Wisconsin praises the SID&T placed column by Advisory Board member Dr. Matthew Cooper. Dr. Johnson continues the rightful assault on the wrongful so-called CMS reforms.

Special to the Milwaukee Journal Sentinel

Federal Organ Donor ‘Reforms’ Are Counterproductive

There are numerous flaws in the CMS analysis, but the most serious flaw is use of national and state death certificate data to determine OPO donor potential.

By Christopher Johnson

May 28, 2026, 5:03 a.m. CT

In a guest column "Federal organ donor 'reforms' proposal puts patients at risk" on March 20, Dr. Matthew Cooper, Chief of Transplant Surgery at Froedtert and Medical College of Wisconsin, sounded the alarm on performance metrics, that will be required in 2026 by The Centers for Medicare and Medicaid for Organ Procurement Organizations (OPOs) throughout the U.S.

The changes, according to The Centers for Medicare and Medicaid, promise "greater transparency, safer practice, more reliable data, better outcomes, etc."

I don’t think so.

“The Centers for Medicare and Medicaid plan to threaten or directly decertify OPO’s that do not rate in the top 25% by “performance criteria”. This will result in many OPOs being forced to “compete” with others for their own territory or outright decertification.”

The agency aims to “simplify” metrics to two parameters: organ donation rate and transplant rate. Donation rate is the number of successful organ donors (donation of at least one organ) divided by donor potential for the service area. Transplant rate is the total number of transplants performed divided by organ donor potential). There are numerous flaws in the analysis, but the most serious flaw is use of national and state death certificate data to determine OPO donor potential.

Death certificate information lacks critical detail and is notoriously unreliable for determining true organ donor potential. Similarly, transplant rates will not be valid since they use the same denominator. Furthermore, transplant rates are controlled by transplant centers, not OPOs.

In addition, OPOs serve diverse populations which have varying rates of chronic diseases and socioeconomic disadvantages. These factors greatly influence organ donation rates but are not taken into consideration.

The Centers for Medicare and Medicaid plan to threaten or directly decertify OPO’s that do not rate in the top 25% by “performance criteria”. This will result in many OPOs being forced to “compete” with others for their own territory or outright decertification.

It is estimated that 60% of OPOs will be in serious jeopardy if the proposed rule is enforced as currently written. If so, there will be significant disruption in the organ donation and transplantation process throughout the country.

OPOs that are threatened or decertified cannot simply be replaced by new or existing OPOs. Productive working relationships between OPOs and donor hospitals are built on trust and collaboration over years; not just in a few days or weeks. Organ donation and transplant rates are likely to go down, not up!

Importantly, the proposal affects only deceased donor organs and transplants.

Wisconsin transplant centers would be affected by the rule, because even though the two state OPOs are currently performing well, organs are now often shared between OPOs in different states and some of the surrounding states will be in immediate jeopardy and not able to operate effectively. We owe it to donor families and organ donors, who so selflessly give the gift of life, to maintain a safe and reliable system.

The changes proposed do not serve donor families or those who are desperately waiting for a life-saving transplant. Of note, there are currently three lawsuits, representing 12 OPOs, which have been filed in attempt to block or alter the rule.

At this point however, it seems that The Centers for Medicare and Medicaid is going to proceed with their plan, despite strong opposition from OPOs and transplant centers.

Concerned readers can contact their local congressional representatives (many of whom are probably not even aware of the situation), to express their dismay and demand that CMS reconsider its counterproductive position on “Regulation of Organ Procurement Organizations.”

Christopher Johnson, MD, is an emeritus professor of surgery at the Medical College of Wisconsin.