Organ Donation

Although advancements in organ transplant technology have increased the number of patients who could benefit from transplants, the supply of organs has not kept pace, and the gap between transplant demand and organ supply continues to widen. GAO has issued several reports in recent years examining the equity of organ allocation decisions, variations in patient waiting times, and the lack of adequate measures to assess organ procurement effectiveness. Most recently, GAO examined the approaches for assessing the effectiveness of organ procurement organizations in increasing the organ supply. (See GAO/HEHS-98-26, Nov. 1997.) This testimony draws on that report and discusses (1) whether the current standard for assessing organ procurement organizations' effectiveness appropriately measures the extent to which they are maximizing their ability to identify, procure, and transplant organs and tissues and (2) alternatives to the current standard that could be more effective.

GAO noted that: (1) the Health Care Financing Administration's (HCFA) current performance standard does not accurately assess OPO's ability to meet the goal of acquiring usable organs because it is based on the total population, not the number of potential donors within the OPOs' service areas; (2) GAO identified two alternative performance measures that would better estimate the number of potential organ donors--measuring the rates of organ procurement and transplantation compared with either the number of deaths or the number of deaths adjusted for cause of death and age; (3) both these approaches have limitations, however, in data availability and accuracy; (4) two other methods for assessing OPO performance--medical records reviews and modeling--show promise because they could more accurately determine the number of potential donors; and (5) because OPOs must meet performance goals to continue to operate, approaches that more accurately differentiate between OPOs that achieve greater or lesser proportions of all possible donations in their service areas can help increase donations.