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New Research Confirms CMS Metrics Measure Demographics, Not Performance
A new study published in the January 2026 issue of Transplantation by Dr. James R. Rodrigue and colleagues provides compelling evidence that CMS’s OPO performance metric is fundamentally flawed. Most critically, the research shows that the CMS metric measures demographics, not performance, penalizing OPOs based on the communities they serve rather than the quality of their work.
The study contributes to a growing body of peer-reviewed research demonstrating that the CMS Final Rule is based on incorrect assumptions and unreliable data.
The CMS Metrics Penalize the Wrong Communities
Rodrigue et al. analyzed how CMS’s tier-based OPO performance system functions in real-world conditions. Their findings are clear:
OPOs serving racially and ethnically diverse populations are far more likely to be penalized—not because of poor performance, but because CMS relies on unadjusted death certificate data that ignores social determinants of health.
This means communities already facing barriers to healthcare access are at greatest risk of losing local donation infrastructure.
High-Performing OPOs Will Be Misclassified
The study shows that the CMS Final Rule misclassifies capable, high performing OPOs as failing because it relies on death certificate data that does not accurately identify donor potential. Specifically it,
Fails to accurately identify true donor potential
Does not account for hospital referral patterns or structural inequities
Misclassifies capable, high-performing OPOs as “low tier”
The CMS metric confuses data limitations with organizational failure. As a result, organizations with strong hospital relationships, effective donor family support, and solid donation outcomes are placed at risk of decertification.
Disruption Without a Plan
The research also underscores that CMS has offered no guidance for how donation services will be maintained if OPOs are shut down across large geographic areas.
There is no plan for:
Continuity of donor family support
Maintaining hospital relationships
Preventing donation slowdowns or organ loss
Abrupt decertification without a transition strategy puts patient lives at risk and threatens continuity of care for donor families and transplant centers alike.
Bad Data Yields Bad Results
Rodrigue et al. reaffirm what decades of transplantation science already show. OPO performance should be evaluated using clinically meaningful measures, such as ventilator hospital deaths and organ yield, rather than raw death certificate data that fails to identify eligible donors. Death certificate data does not identify eligible donors and was never designed to evaluate donation performance.
Using the wrong data produces the wrong results and destabilizes a system that patients depend on for lifesaving transplants.
Supporting Reform Grounded in Science
SID&T supports reforms grounded in science, transparency, and best practices. The findings of this study align with the Congressionally mandated NASEM Report, which outlines a clear path to improving donation and transplant outcomes without destabilizing the system.
Real reform improves performance, protects equity, and saves lives. Science shows the CMS Final Rule does not.
SEE THE SUMMARY AND ABSTRACT CITATION: https://sidandt.org/the-science/peer-reviewed-science