Abstract
Introduction
Hospitals in the United States are assigned to a designated organ procurement organization (OPO) responsible for managing deceased donors in the designated donation service area (DSA). Hospitals can apply for waivers to work with a different OPO with appropriate justification. We sought to evaluate the impact of hospital waivers on organ donation activity.
Methods
We evaluated Organ Procurement and Transplantation Network (OPTN) data from two OPOs (Donor Network West and Honor Bridge), each with a hospital (Renown Regional Medical Center and North Carolina Baptist Hospital) in its DSA granted a waiver to work with a different OPO beginning in April 2025. We assessed changes in the number of organ donors and organs transplanted pre- and post-granting of a waiver using a difference-in-differences approach based on multilevel mixed-effects models.
Results
After switching OPO affiliations, mean monthly donors at intervention hospitals increased from 5.6 pre-waiver to 7.9 post-waiver, while control hospitals remained stable (56.6 vs. 57.5 donors/month). Mean monthly organs transplanted increased from 16.5 to 24.9 at intervention hospitals, while control hospitals were unchanged (170.9 vs. 169.3 organs/month). The difference-in-differences interaction term was statistically significant for both donors recovered (p < 0.1) and organs transplanted (p < 0.1). Reported deaths were stable in both groups.
Conclusion
With eight months of post-waiver data, hospitals with granted waivers had significant increases in donation activity driven by improved donor conversion rather than changes in referral patterns or organ yield per donor. Although longer-term data are needed to confirm these findings, CMS and the organ transplant community should feel confident that changing donor hospital-OPO affiliations will not negatively impact donation and may lead to significant increases in donation.