Organ Procurement Organization performance varies widely, according to new study findings published in JAMA Surgery. Investigators suggest suboptimal performance of these organizations may indicate lost opportunities to recover organs for transplantation during an era of high demand and a nationwide shortage.

Focusing on Organ Procurement Organization performance at individual hospitals could eliminate the shortage of heart, liver, and lungs and increase the kidney supply, according to Seth J. Karp, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues.

The investigators compared donor potential to actual donors in a cross-sectional study of 2 Organ Procurement Organizations representing 13 hospitals in 2 donor service areas. They reviewed 2008 medical records of deceased patients from 2017-2018 to estimate 8925 total individual inpatient deaths. Based on their estimates, they identified 931 potential donors at these hospitals with ventilation or causes of deaths consistent with donation. The actual number of donors was 242.

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The rate of conversion of potential donors into actual donors among the 13 hospitals ranged from 0% to 51%. One of the Organ Procurement Organization obtained organs from 48.2% of potential donors, whereas the other organization obtained organs from only 18.8% of potential donors.

“The performance of the OPOs was moderately related to referrals of ventilated patients and not related to [transplant] center acceptance practices,” Dr Karp’s team noted.

“We therefore conclude that the vast majority of missing donors arise in the space between the [OPO] referral and [transplant] center acceptance.”

According to the investigators, these findings support Centers for Medicare & Medicaid Services’ Organ Procurement Organization oversight measures and congressional calls for OPO process data to increase transparency.

In an accompanying editorial, Jayme E. Locke, MD, MPH, and Robert M. Cannon, MD, MS, of the University of Alabama at Birmingham Heersink School of Medicine, commented:

“This important study by Johnson and colleagues shines some light in only a very small corner of the OPO world. The time for the sun to shine on the whole world of organ donation through the development of a comprehensive, mandatory, and publicly available data source relevant to OPO performance is long past overdue.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Johnson W, Kraft K, Chotai P, et al. Variability in organ procurement organization performance by individual hospital in the United States. JAMA Surg. Published online February 8, 2023. doi:10.1001/jamasurg.2022.7853

Cannon RM, Locke JE. It is time for the light to shine on organ procurement organizations. JAMA Surg. Published online February 8, 2023. doi:10.1001/jamasurg.2022.7857