In order for ours to maintain its status as the best in the world, every segment of the organ procurement and transplant process in the United States must be held to the highest ethical standards. When it comes to facilitating the life-saving decision by a donor family to give a part of a loved one, all the way through the process to the actual transplantation that gives another person a chance to live, anticipated health outcomes should be the only metric that truly matters.
That is why Science in Donation, the non-profit organization of organ donation professionals, physicians, recipients, and donor families devoted to supporting, educating, and advocating on behalf of the interests or members of the donation and transplant communities, continues to shine a light on the issues and forces shaping the public health policy in organ donation and allocation.
Recently enacted rules for the system that, up until now, was driven by the altruistic work of 58 organ procurement organizations (OPOs), turn a blind eye to the racial disparities that exist within our nation’s healthcare system, a fact that alone makes them, at worst, meritorious of further discussion and consideration.
Given the origination of the rules, and the clear intent of those behind them to turn the system into one that focuses on profit, not people, it comes as no surprise that the metrics they impose appear deliberately naive to the tangible and measurable role racial and ethnic demographics play in healthcare delivery.
They also fly in the face of one of President Joe Biden’s first Executive Orders which directed that “racial equity strategies must be systematic, race-explicit, and outcome oriented if they are to succeed.” These rules, as promulgated, are anything but.
By failing to recognize the deep and meaningful relationships that many OPOs have built within their regions with diverse communities, and offering no encouragement, or obligation, to enact corrective action by the few lacking in this arena, those that choose to overcome racial and ethnic barriers are put at a disadvantage.
Rulemakers took this apparent contempt for a successful system in need of adjustment, not complete ruin, a step further by using data derived from death certificates as the determining factor for donor eligibility, and therefore OPO, performance. This comes over the objection of medical examiners, coroners, and other health experts that warned such a process, by failing to note several conditions that would preclude organ donation, would erroneously drive up what regulators would consider failure in this arena.
While these new rules are now in place, and what appears to be an attempt to dismantle a proven organ donor network that has seen five straight years of record-breaking transplants is well underway, there is good news. It’s not too late to fix them.