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NASEM Study Confirms Key Advocacy Points of SID&T Reform Movement

Science in Donation & Transplant, a non-profit advocating for true science based-reform, today lauded the release of the study by NASEM mandated by Congress entitled “Realizing the Promise of Equity in the Organ Transplantation System.” * https://doi.org/10.17226/26364

SID&T Chairman Anthony Pizzutillo stated “For eighteen months SID&T has advocated for true reform in the donation and transplant system based on peer-reviewed science, not politics, as the path to better patient results. NASEM’s study confirms point after point of our advocacy by separating fact from fiction, calling for better alignment and accountability among organ procurement organizations, transplant centers and hospitals, and adopting logical and proven metrics to evaluate the performance of the various components of the donation and transplant system.”

“We encourage the Centers for Medicare and Medicaid in the Department of Health and Human Services to adopt these approaches as SID&T presented in our response to their recent Request for Information for improving the Rule.”

The NASEM study support a number of the reforms advocated by SID&T.

NASEM notes that good kidneys are often not used.

Transplant Centers reject organs at a much higher rate than Europe. Again, de-certifying OPO’s based on transplant rate which they do not control is an illogical answer to improving patient result. Better alignment, coordination and metrics among OPO’s transplant centers and hospital is the right approach.

Donate Life analysis shared with CMS through our RFI response shows that under the Rule the numbers of future donations will lag behind the curve expected under the previous Rule.

NASEM recommends increasing the utilization rate of donated organs. We again strongly agree that results show (in their words) “It is too easy for transplant centers to decline usable organs, and accountability for transplant center decision making is lacking.”

SID&T advocates for better alignment among the donation and transplant entities. We strongly support NASEM identifying their “Statement of Task”:

“Better align the performance metrics of various stakeholders within the Organ Procurement and Transplantation Network (OPTN) - donor service areas, organ procurement organizations, and transplant centers - to maximize donor referrals, evaluations, procurement and organ placement/allocation while minimizing organ discard rates.”

CMS needs to improve the performance metrics in the Rule. We have advocated for this NASEM study conclusion.

“Creating standardized, consensus-based metrics to compare performance of donor hospitals, OPOs, and transplant centers needs to be a priority for HHS and the OPTN.”

The critical area of health equity is addressed by NASEM. SID&T recognizes and advocates for reform of CMS’ current Rule which does nothing to address racial reality. In fact, their decertification metrics may exacerbate this NASEM conclusion:

“Black patients have a 37 percent lower chance of being referred for a kidney transplant prior to beginning maintenance dialysis (preemptive kidney transplantation).

Patients who are white, have greater health literacy, and have private health insurance have greater access to preemptive kidney transplantation.”

SID&T concurs that CMS needs to focus on the entire system, that indeed transplant center performance varies widely and directly impacts the donation rate that just OPO’s are judged upon. SID&T supports this health equity recommendation of the NASEM study as cited in their announcement webinar.

“Within 1 to 2 years, HHS should publish a strategy with specific proposed requirements, regulations, payment structures, and other changes that will lead to the elimination of disparities.”

Science in Donation and Transplant is a non-profit devoted to the support and education of members and stakeholders in the donation and transplant communities. Donors and transplant recipients alike deserve a well-aligned, science-based system. We advocate in concert with leading medical practitioners for enhanced coordination and alignment among organ procurement organizations and transplant centers. Our goal is ensuring that the metrics and measures used to credential, license, designate and certify donation and transplant organizations are grounded in science and protected from political whim and private financial influence.