As directed by President Trump in his July 10 Executive Order on Advancing American Kidney Health, the Centers for Medicare & Medicaid Services (CMS) is issuing a proposed rule to change the way organ procurement organizations (OPOs) are held accountable for their performance, and the Health Resources and Services Administration (HRSA) is issuing a proposed rule to remove financial barriers to organ donation.
“The American Society of Transplant Surgeons applauds the Administration’s continued efforts to improve access to transplantation by increasing the organ supply, and hence the number of transplants,” said Lloyd E. Ratner, MD, MPH, ASTS President. “By increasing the number of transplants, we are confident that deaths on the waiting list will be lessened, a goal we share with the Administration. Increasing the number of organs available by modifying performance metrics for Organ Procurement Organizations and removing disincentives to living organ donation by covering expenses for lost wages, child care, and elder care through the National Living Donor Assistance Center are two promising avenues to address the unmet need for organs. We look forward to working with the Ce nters for Medicare and Medicaid Services and the Health Resources and Services Administration on operationalizing optimal proposals, once they are finalized.”
ASTS plans to submit comments as appropriate and encourages all members to weigh in on both proposals. Public comments are due 60 days after publication of the rules in the Federal Register.
OPO Metrics
CMS estimates that if all OPOs were to meet both the donation and transplantation rate measures, the number of annual transplants would increase from about 32,000 to 37,000 by 2026, for a total of almost 15,000 additional transplants in that time.
The proposed rule would use objective and reliable data, incentivize OPOs to ensure all viable organs are transplanted, and hold OPOs to greater oversight while driving higher OPO performance. CMS is proposing:
Most of the proposed changes would not take effect until 2022. However, CMS intends to make these outcome measures public during the next four-year OPO recertification cycles once the rule is finalized.
Comment on OPO metrics proposed rule
NLDAC Expansion
HRSA’s proposed rule would expand the scope of reimbursable expenses for living donors to include lost wages, and childcare and eldercare expenses for those donors who lack other forms of financial support via the National Living Donor Assistance Center. This proposal could increase the number of transplant recipients receiving a better quality organ in a shorter time period from living donors. HRSA also is reviewing a notice that would increase the income threshold for living donors eligible for reimbursements.