Many members have inquired about the AST's role, engagement, and impact in addressing the ongoing and quite fluid HHS-HRSA OPTN modernization process. Rest assured that your Society has been, and continues to be, at the table with HHS, HRSA, Congress, patients, and the stakeholder community from day one. The AST has worked diligently from the very beginning to strategically position the Society to keep the door open for engaging our government partners and all stakeholders throughout the modernization initiative.
Although opinions have varied within the AST membership regarding the appropriate strategies and tactics for addressing OPTN modernization, the Society has stayed on a path of close engagement and collaboration with all parties involved. These efforts have included, but are not limited to, countless meetings with members of the U.S. Senate and House of Representatives, AST Capitol Hill fly-ins dedicated to OPTN modernization and reform, grassroots initiatives, joint stakeholder communications, and many in-person and virtual meetings with senior HHS and HRSA Division of Transplantation officials.
Regarding HRSA's Division of Transplantation, we are encouraged by the recent hiring of Dr. Jayme Locke, Director of the Division of Transplantation, HRSA, and Dr. Raymond Lynch, Organ Transplantation Branch Chief - Division of Transplantation, as they bring deep expertise to the conversation.
At the same time, we recognize the significant bipartisan congressional forces involved and continue to implement a three-rail strategy engaging Congress, HRSA, and the community to ensure that the AST voice is clearly and effectively communicated to all key decision-makers.
AST's Actions and Advocacy Efforts
OPTN Modernization Task Force: We developed an OPTN Modernization Task Force as an advisory group to the AST Board, ensuring we are prepared to respond to modernization efforts. This group created a document outlining key principles which has been used in discussions with policymakers.
Capitol Hill Engagement: Our team has actively discussed these principles with congressional offices—many of whom were unaware of OPTN modernization. These conversations have been well received, reinforcing the need for expert input.
AST Public Policy Form: An email was sent to AST members in June 2024, describing discussions about OPTN modernization that occurred during the 2024 American Transplant Congress, reviewing the AST's strategy and involvement in OPTN modernization efforts, and providing members a tool to share their ideas and feedback about OPTN modernization with AST leadership. We continue to encourage members to use the AST Public Policy Form to share your thoughts about OPTN modernization, including suggestions on how AST might approach specific topics within modernization.
Ongoing Policy Development: In response to discussions at ATC and other OPTN-related concerns, we developed a second document with further comments and principles following the September 11, 2024, House Energy and Commerce Subcommittee on Oversight and Investigations OPTN hearing.
Upcoming Policy Engagement: AST Secretary Dr. Nicole Turgeon has been selected to present at the 2025 Sanofi Transplant Policy Round Table on February 18, where she will join leaders from other transplant organizations. This important discussion will focus on how we, as transplant experts, can work collaboratively to shape policy that will advance key areas of the field, including OPTN modernization.
The AST remains committed to advocating for an efficient, equitable, patient-centered transplant system. We will continue to provide regular updates on this topic and encourage members to stay engaged on our public policy page. Here are key examples and a timeline of the AST's ongoing engagement in OPTN modernization.
March 2024 – Introductory Meeting with HRSA
AST leadership met with Dr. Suma Nair, Associate Administrator, Health Systems Bureau, HRSA, following initial discussions at the 2024 Cutting Edge of Transplantation (CEoT) meeting. We highlighted AST's diverse membership across all organ transplant specialties, reinforcing our role as an engaged stakeholder in OPTN modernization and HRSA's integration plans.
June 2024 – AST Town Hall with HRSA
This session covered OPTN Board nominations, budget considerations, independent board support contractors, and committee policies. The AST provided input on these discussions.
June 2024 – Follow-Up Meeting with HRSA
This discussion clarified HRSA's plans to shift from a single-contractor model (UNOS) to multiple contractors handling different aspects of the OPTN mission. A new OPTN Board will be formed through a special election, retaining its role in policymaking, allocation, and oversight of OPOs and transplant programs. Selected contractors will provide input to the board, but final decisions will likely rest with HRSA. The AST strongly advocated for transparency in this process and thorough communication with the transplant community to ensure its complexities are well understood.
July 2024 – Meeting with the Government Accountability Office (GAO)
The Government Accountability Office (GAO), which provides oversight and evaluation of federal programs, conducted a review of the organ procurement and transplantation system. Given the AST's broad representation through its 16 Communities of Practice (COPs), the Society was invited to share insights with the GAO. Members of the AST Executive Committee met with representatives of the GAO to assist in the agency's OPTN report. Discussions focused on how transplant providers interacted with the OPTN, the effectiveness of its services, oversight roles, the impact of the OPTN modernization initiative, and opportunities for interim improvements in coordination between HRSA and CMS. The AST's recommendations and observations were ultimately included in the final government report.
October 2024 – HRSA Meeting on Board Nominations
The AST's leadership met with HRSA to discuss the process for selecting a nominating committee for the new OPTN Board. It was confirmed that previous OPTN Board members and leadership would not be eligible. The AST emphasized the need for community input and submitted seven nominees for consideration. Discussions also covered four key contractor domains: transformational services, OPTN operations, IT and data, and communications. HRSA confirmed that any updates to OPTN bylaws would go through the public comment process. Future meetings with HRSA at the 2025 Cutting Edge of Transplantation (CEoT) and World Transplant Congress meetings were proposed.
January 2025 – ASTS Winter Symposium
The AST commends ASTS for bringing the transplant community together to present a unified voice to HRSA. At the symposium AST President-Elect David Foley participated in a transplant stakeholder meeting to discuss AST's position on OPTN modernization and best strategies to collaborate with other societies in optimizing advocacy efforts. To continue this collaboration, the AST is arranging a virtual meeting with HRSA (Drs. Locke and Raymond Lynch) during CEoT 2025 at the end of February. All transplant community stakeholders will be invited, and direct questions to Drs. Locke and Lynch will help ensure more substantive responses from transplant physicians now representing HRSA.
AST Major Principles for OPTN Modernization Initiative
The AST's desired outcomes for OPTN modernization focus on three core elements necessary to achieve a more efficient transplant system that improves patient and donor outcomes. Modernization should strive to:
- Coordinate efforts across and within government agencies,
- Strengthen, enhance, and maintain stability of the transplant system, and
- Improve data analysis capabilities as part of a strong information technology system.
Learn More by Attending the Cutting Edge of Transplantation (CEoT) Meeting
To stay informed and engaged in critical discussions surrounding OPTN modernization, we encourage you to attend CEoT 2025 from February 27 - March 1 in Scottsdale, AZ. This year's meeting will focus on transplant modernization, bringing together experts, policymakers, and transplant professionals to explore the latest developments and strategies shaping the future of transplantation.
Don't miss this opportunity to be part of the conversation. Learn more and register here.
Sincerely,
Jon Kobashigawa, MD
AST President
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