The American Society of Transplantation (AST)—an organization of more than 5,000 professionals dedicated to advancing the field of transplantation and improving patient care—recognizes the need for improvements to the solid organ transplantation system in the United States. Accordingly, the AST is supportive of the intent behind work to optimize the Organ Procurement & Transplantation Network, also known as OPTN Modernization.
Existing Challenges in the Organ Procurement and Distribution System
The core challenge faced by the U.S. organ transplantation system is one of high demand and limited available organs. Achieving optimal efficiency and equity at the system level requires strong coordination among the federal agencies, health systems, health care providers, and other entities in the transplantation ecosystem. Despite best efforts, system-based challenges remain to achieving effective collaboration. These challenges can result in conflicting policies that may contribute to increased organ non-utilization rates. Now is the ideal time to address these and other challenges as Congress and HRSA consider changes to the structure and function of the OPTN.
Desired Outcomes for OPTN Modernization 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.
Coordinate efforts across and within government agencies A broad array of federal agencies within and external to the Department of Health and Human Services impact organ transplantation. The AST is encouraged by efforts to better coordinate the work of HRSA and CMS via the Organ Transplantation Affinity Group, but additional inter-agency collaboration is necessary. For example, the Centers for Medicare & Medicaid Services (CMS) launched a program employing value-based metrics for transplant hospitals and organ procurement organizations (OPOs); however, the Human Resources and Services Administration (HRSA) has limited involvement in this initiative. Further, there is a need for better alignment of policies regulating organ procurement organizations (OPOs) and transplant hospitals. All transplant-related policies must align to improve patient and donor care.
Strengthen, enhance, and maintain stability of the transplant system Existing systems for organ procurement, allocation, transportation, and transplantation are complex. Therefore, it is essential that changes to the OPTN be implemented cautiously and with an eye toward avoiding unintended consequences. The AST recommends that modifications be introduced in phases to promote and evaluate the effectiveness of each change. To help avoid unintended consequences, the AST believes it is critical that meaningful engagement of stakeholders, including the patient and transplant community voice, be sought early and often.
Increasing data analysis capabilities as part of a strong information technology system
Strong information technology and data analytics are core to improving the care of individual transplant patients and donors. This involves data used for activities that range from transplant referral to monitoring long-term patient outcomes. In addition, the availability and usability of these data are essential to research that will advance the field. For example, the AST supports HRSA’s work to improve data collection for transplant and donor referrals, which can guide clinical decision-making and inform broader efforts around equity.
Next Steps
With coordination and strong systems, we can realize the full potential of organ transplantation to improve patient lives and reduce health care costs by avoiding other costly medical interventions. The diverse membership of the AST has the expertise and insights needed to truly modernize organ procurement, allocation, transportation, and transplantation. Further, the AST believes that there are other opportunities to improve the field of transplantation, including research funding from the National Institutes of Health and improvements to Food and Drug Administration policies that provide patient access to novel drug therapies. We look forward to partnering and collaborating with Congress and the Department of Health and Human Services in these efforts.
Approved by the AST Board of Directors on January 24, 2024
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