Trump administration proposes new rules to increase organ transplants

The Trump administration proposed new rules Tuesday to increase organ transplants for the more than 113,000 Americans currently on waiting lists.

The rules aim to remove financial barriers that deter living donors and set higher standards for organ procurement organizations (OPOs).

“There are few more transformative interventions for someone’s health than by replacing a failing organ with a healthy one, and that’s what we’re aiming to make much more common with our proposals today,” Health and Human Services Secretary Alex M. Azar II said Tuesday.

If finalized, the rules would reimburse donors for lost wages and expenses such as child and elder care incurred during hospitalization. They also would track OPOs’ donation and transplantation rates using federal death records that include the entire pool of possible donors each organization can pull from.

According to HHS, almost 8,000 Americans die each year waiting for an organ transplant.

“There are thousands of organs that could be available for use, and many Americans who might be willing to become a generous living donor,” Mr. Azar said. “Unfortunately, today and for decades, we haven’t done everything we can to procure organs from deceased donors, and we haven’t been providing enough support for living donors.”

The proposed rules build on President Trump’s executive order in July to improve care for kidney disease, which includes increasing access to organ transplants.

Kidneys are the most needed organs for transplants. About 96,000 people are on the national waiting list for kidney transplants.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), said 1 person is added to a transplant waiting list every 10 minutes, and 20 people die every day because they can’t get an organ.

“Government’s misaligned regulatory incentives aren’t procuring enough kidneys, hearts, lungs, and other organs to fulfill the demand. But those 20 deaths each day can be avoided,” Ms. Verma said.

OPOs’ performance currently is based on self-reported data. CMS is proposing to complete 12-month reviews of OPOs throughout the four-year recertification cycle for Medicare to identify organizations that need improvement and increase the number of transplants.

Under the proposed rules, the organ procurement organizations would have to match the donation and transplantation rates of the top 25% of OPOs.

The Association of Organ Procurement Organizations, which represents 58 federal OPOs, said it welcomes the proposed rules as a way to drive changes that will increase the availability of organs and save more lives.

“An independent, verifiable metric for evaluating OPO performance can be an important tool, helping to identify potential opportunities for growth, in OPOs’ quest for continual improvement,” said association President Kelly Ranum, CEO of the Louisiana Organ Procurement Agency. “We look forward to working with CMS on implementation of the rule and ensuring the metric is used to drive the changes everyone in the donation and transplantation community wants to see.”

CMS estimates the number of yearly transplants would jump from 32,000 to 37,000 by 2026 if OPOs meet donation and transplantation targets.

Ms. Verma said current rules disincentivize OPOs from trying hard to procure every possible organ, such as imperfect organs from donors who might be older or have certain medical conditions.

Patients who receive kidneys from living donors tend to receive better quality organs in a shorter time frame. However, fewer than 7,000 of the more than 36,500 transplants last year included organs from living donors.

The Association of Organ Procurement Organizations said the U.S. set a record with transplants last year, with 10,721 deceased donors supplying 32,857 organs. This year is on pace to be another record year.