Monday, August 19, 2019

It’s time to eliminate the monopolies in organ donation

We have always been told that competition makes people or businesses better, right??  It pushes us to work a little harder which at the end of the day makes better us than the person who doesn’t.  If there is no competition, there is no incentive to try and get better.  These rules apply for pretty much anything in life and would also apply for the 58 government-granted monopolies that are the organ procurement organizations (OPO) in the United States.

What is an OPO exactly??

The OPOs were created following the adoption of the National Organ Transplant Act (NOTA) in 1984.  This law established the Organ Procurement and Transplantation Network (OPTN) which standardized the transplant process in the US.  The way the organ donation process was standardized was with the creation of the OPO.  They are regulated by multiple government agencies including Medicare.

Why are they government-granted monopolies?

The territory given to each single OPO belongs only to that one OPO.  Some states have more than one OPO and some states share the same OPO.  The size of each state determines the territory each OPO has to cover.  For states with more than one OPO they divide the state in a way that it is very difficult logistically to cover everywhere.  Look at the Texas map by example.  It doesn’t make sense that Galveston (45 miles south of Houston) is not deserved by the OPO based out of Houston (LifeGift).  That territory is under the control of the OPO from Dallas, Southwest Transplant Alliance.  Galveston has a large trauma center that covers a large part of the Texas upper coast which means there is a huge potential for donors.  They only had 8 donors for 2018 when smaller hospitals with no trauma had about the same numbers.

How to increase the number of donors?

The boundaries between OPO should be open for competition which means they would not be constraint to a pre-determined geographical region.  It would make a lot more sense for the OPO in Houston to cover Galveston than sending people from Dallas.  I am sure there would be plenty of other examples in the country where an OPO from the state next door would be able to do a better job than the one assign to that territory whether it is logistics or operational reasons.   The better performing OPO would be left standing and a better utilization of the organs would ensue.

I forgot to mention a previously repeated experience with an OPO from the south.  They seem to have an official cut off time of 8-9 pm for the procurement time.  The surgeons they work with don’t want to procure at night so they eventually quit trying to place organs once they are getting close to 8-9 pm.  Countless times we were interested by an organ and they shut us down by saying “too bad, we are going to the operating room in 2 hours whether you can make it or not”.   Open competition and this behavior will disappear.  This practice does not honor the sacrifice donors and their families are going through.

Opening the boundaries will force the OPO to get better and maybe collaborate in cases where they are really busy and need help from another OPO in order to help with a donor.  Or in the case of Houston, just have LifeGift cover Galveston.

Pierre Luc Charland
Pierre Luc Charlandhttps://www.transplantcafe.com/profile/Pierrecharland
Aside from being a very experienced transplant coordinator in the Houston area, Pierre is also an amazing content creator for our properties. Pierre plays a key role in driving our mission and offering expert insight to the ever evolving world of transplantation.

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