It Is Time for the Light to Shine on Organ Procurement Organizations

In this issue. Johnson and colleagues' shine some light into one corner of the generally murky world of organ procurement organizations (OPOs). In a study of 2 OPOs involving direct medical record review, the authors found that only 26% of potential donors actually proceeded to organ donation. Even more striking is the vast difference in performance between the 2 organizations. While OPO-2 was able to reach organ donation with 48.2% of potential donors. OPO-1 was able to reach organ donation with only 14.2% of potential donors, a 237.5% difference. To put this gap in context, it is worth considering performance variability in transplant centers, who are the end users of service provided by OPOs. In the most recent reported year, the relative difference in 1-year graft survival between the lowest- and highest-performing liver transplant centers in the United States was only 28%. For kidney transplant centers, this number was 40%; for heart transplant centers, it was 140%; and for lung transplant centers, it was 200%. If all heart, lung, liver, and kidney programs in the most recent year with higher-than-expected 1-year graft loss were to perform as expected, this would have resulted in 658 fewer graft losses.2 If OPO-1 had performed similar to OPO-2, this would have resulted in 206 additional donors.