An organ for every eligible transplant recipient may be within our grasp
Unprecedented things are happening in the field of organ donation and transplantation, heralding a foreseeable future in which every person eligible for a transplant receives one.
In May, the nation’s four historically Black medical schools—Charles R. Drew University of Medicine and Sciences, Howard University College of Medicine, Meharry Medical College, and Morehouse School of Medicine—announced a collaboration with the Association of Organ Procurement Organizations and the Organ Donation Advisory Group to increase the number of Black registered donors and transplant recipients, as well as the number of Black medical professionals in the field.
The collaboration’s initiatives were driven in large part by an independent report released in February from the National Academy of Science, Engineering and Medicine. The NASEM report, titled “Realizing the Promise of Equity in the Organ Transplantation System,” calls for transformative improvements in our system in three key areas: equitable allocation of organs, maximum usage of those organs and overall system performance.
It sets benchmarks for an increase in organ transplants to 50,000 annually by 2026, and it enumerates the steps necessary to escalate both donation and transplantation rates among minority and disadvantaged communities.
But too often reports call for big improvements, set benchmarks and then languish. But not this time. In April, the Department of Health and Human Services put out a request for information that asks system stakeholders to recommend ways to make the goals of the NASEM report a reality.
This is a big deal, setting the stage for NASEM’s transformative solutions to heavily influence the contract HHS issues in 2023 to run the federal system, known as the Organ Procurement and Transplantation Network, for the next five years.
Which brings us to the most consequential development of all: Our national donation and transplant network—which comprises 250 transplant hospitals, 57 organ procurement organizations, more than 5,000 donor hospitals, thousands of government regulators, healthcare professionals and volunteers, and countless numbers of patients and potential donors—is already primed and ready to achieve the report’s goals.
In addition to the recently announced HBCU medical school/OPO collaboration, other innovations and advancements either in the works or in progress are policy changes to organ allocation that provide a more flexible model for assessing all factors simultaneously and helping ensure the sickest patients receive organs first. In addition, research breakthroughs have expanded the donor pool and increased the number of life-saving organs by including those who have died after their heart has stopped and enabling organs to be repaired after they are removed from the body.
These are just a few of the latest and most exciting initiatives and innovations. All that is needed now is a regulatory framework that drives the system to work cohesively and collaboratively in the best interests of donors and patients. It now appears that HHS, informed by NASEM, intends to do exactly that. Two of the most significant NASEM recommendations are:
• Incentivize transplant programs to use less-than-perfect organs and inform their patients that these are available, accompanied by research that demonstrates such organs have little effect on health outcomes. This is projected to significantly decrease the number of organs that go unused. NASEM estimates this could reduce the rate at which kidneys are discarded from 25% to 5% in five years.
• Reduce racial disparities in transplantation by making sure patients who are diagnosed with a disease that may lead to organ failure are promptly referred for medical treatment. The report points out that Black Americans suffer from kidney failure (which accounts for the majority of transplants) at three times the rate of whites but are often referred for medical treatment and placed on the transplant wait list far later.
Most significantly, it is the overall approach of “Realizing the Promise of Equity in the Organ Transplantation System” that, to us, is so heartening. The report urges changes to the system that motivate all stakeholders to work collaboratively; and it recognizes that the gifts of donors and donor families, who make the entire system possible in the first place, must be honored.
These are the foundations the system was built upon in its early years, back when we first entered it. This is the reason our system, which achieved a record 41,000 transplants in 2021, has come so far already. Continuing our commitment to two core values—collaboration across the system and appreciation for the donors and donor families who make it possible—will advance it even further, not at some distant time but in the near future. We can see true equity here and believe collaboration and respect for every organ donated will lead us there.