Expose OPOs to Competition.

• Author: Sutton, Abe

Through the National Organ Transplantation Act (NOTA) of 1984, Congress set up a system of monopoly contractors to supply transplant organs and, roughly speaking, gave them blank checks from the taxpayer. The results have been disastrous. Thirty-three Americans die every day waiting for a lifesaving organ transplant--a stark indicator that the nation's organ donation system needs urgent reform.

Organ donation in the United States is managed by 57 organ procurement organizations (OPOs) that are responsible for coordinating local organ recovery efforts. An organ procurement and transplantation network (OPTN) is responsible for overseeing the national system.

Earlier this year, the Centers for Medicare and Medicaid Services identified the majority of OPOs as failing critical performance measures. The OPTN contractor, United Network for Organ Sharing (UNOS), is the subject of a bipartisan investigation by the Senate Finance Committee, which highlighted "serious concerns related to UNOS' role in overseeing our nation's OPOs."

OPOs are failing those in need of a transplant by leaving an estimated 28,000 organs unrecovered each year. The House of Representatives Oversight Committee held a bipartisan hearing on the system in May 2021, noting that "OPOs have a history of poor performance and mismanagement, and they have passed costs for unnecessary luxury items onto taxpayers." The Senate Finance Committee is investigating the OPOs for deadly patient safety issues, wasted taxpayer dollars, criminality, and the failure to recover organs. The House Appropriations Committee has highlighted the need for reform of the OPTN.

Market power / Critical ingredients of any productive reform would be for the U.S. Department of Health and Human Services to focus on the removal of barriers to entry for new organ procurers, an increase in transparency for all contractors, and hewing to basic principles of good governance and federal contracting. The logical first step would be for the Health Resource and Services Administration (HRSA) and HHS to insist upon competitive OPTN contracts consistent with standard government contracting policies.

The organ procurement policies have, in essence, prioritized OPOs' incumbency at the expense of patients' lives, and the monopolistic structure of the OPTN has undermined systemic pressures to improve, while patients are left to languish. While 90% of Americans support organ donation, an HHS-funded study showed that government...