US Regulators to Shut Down Underperforming Organ Procurement Organizations
Federal regulators are moving to crack down on substandard coordination nonprofits and preparing to shut down low-performing groups by early next year, stateline.org reported. Under new metrics from the Centers for Medicare and Medicaid Services, 55 organ procurement organizations will be scored on donation and transplantation rates, placing them into three distinct tiers with the bottom tier facing total contract revocation.
Performance Tiers Determine Organ Procurement Contract Renewals
The updated evaluation framework sorts the nation’s 55 organ procurement organizations into three performance categories. Top-tier organizations—calculated in the top 25% for donation and transplantation rates—will receive automatic contract renewals for another four years. Second-tier groups will have an opportunity to improve and reapply for certification, while those ranking in the bottom tier face complete decertification. According to federal data from July, more than 109,000 people remain on waiting lists nationwide for organ procurement, with the majority awaiting kidneys and about a dozen patients dying each day waiting for an organ.
The Centers for Medicare and Medicaid Services first announced the framework in 2020 following an executive order from President Donald Trump, later releasing proposed revisions earlier this year. While the agency has not yet released which organization contracts will be renewed or dropped, officials stated in March that the process would begin late this year. Current four-year contracts expire in January, though the agency plans to issue extensions as needed to maintain uninterrupted transplant operations.
Nonprofits Face Scrutiny over Transplant Disparities and Practices
State- and region-based nonprofits recover organs from deceased donors and coordinate with families and transplant centers. These organizations faced intense scrutiny following media reports and research papers detailing practices such as skipping over certain transplant centers and sicker patients, which researchers say worsens racial and socioeconomic disparities in organ transplants. Federal authorities have shut down at least two groups in the past two years due to questionable practices, including instances where workers ignored signs of consciousness in donors.
Medical and policy experts have voiced varied opinions on the impending changes. Professional groups like the American Society of Transplant Surgeons support the evaluations, calling the decertification of a Miami group last year a powerful decision that strengthens the system. Conversely, the Association of Organ Procurement Organizations warns that nearly 42% of the 55 organizations could fall into the bottom tier for automatic decertification, potentially disrupting logistics around organ donation coordination. Jeff Trageser, the association’s immediate past president, noted that while underperforming nonprofits must be held accountable, many groups argue that overall transplant rates fall outside their direct control.
Nonprofits Sue to Block New Evaluation Framework
Nonprofits have filed several lawsuits to block the rule, most recently in August when a Hawaii nonprofit sued to challenge the framework. In a separate case, a federal district court in Florida recently upheld the rule following a lawsuit brought by organizations serving California, Florida, Georgia, Iowa, Puerto Rico, Texas, and Washington state. The nonprofits have appealed that ruling.
In legal complaints, organizations characterized the evaluation method as a competitive approach that could destabilize the nation’s organ donation network. Dr. J. Thomas Rosenthal, board secretary of OneLegacy—the organ procurement nonprofit serving Los Angeles and surrounding counties—warned that shutdowns could fracture trust built over years within local communities, particularly among communities of color with historic medical system distrust.