Medicare Proposes New Transplant System Rules That Might Spur Use of Less-Than-Perfect Organs
The government has proposed new rules for the nation's transplant system that aim to increase use of certain donated organs and set additional safety standards for donor groups.
The Centers for Medicare and Medicaid Services said the proposal would strengthen its oversight of organ procurement organisations or OPOs, groups that retrieve organs from deceased donors.
Addressing the Transplant Waiting List Crisis
More than 100,000 people are on the U.S. transplant list, the vast majority seeking a kidney, and thousands will die waiting for a new organ. Wednesday's move is part of an ongoing overhaul of the complex transplant system that began during the first Trump administration.
But it comes after donations from the deceased dropped last year for the first time in over a decade, sparking concern about mistrust in the system. While organ transplants have been rising – just over 49,000 last year compared with 48,150 in 2024 – that year-over-year increase also slowed.
"Every missed opportunity for organ donation is a life lost," CMS Administrator Dr. Mehmet Oz said in a statement Wednesday. He said the proposed rule, expected to be finalised later in the year, "strengthens accountability, clarifies expectations and gives us stronger tools to remove underperforming organisations, protect patients and honor the incredible gift of life."
Maximising Use of Medically Complex Organs
In a step toward more potentially usable organs, the proposal urges maximising the use of "medically complex organs," typically those from older or sicker donors. CMS would add new requirements for how OPOs track the retrieval and usage of those less-than-perfect organs, which the agency said may need "special or additional considerations" in finding an appropriate recipient.
Many OPOs already have increased retrievals of those less-than-perfect organs, especially kidneys. For example, a less-than-perfect donated kidney might not be good enough to last the lifetime of a young recipient but it could give an older, sicker patient, who might not get another offer, some time off dialysis. Yet for a variety of reasons, many transplant centres don't accept medically complex donated organs even when medical criteria suggest they'd be a good match for a patient.
Industry Response and Future Implementation
Jeff Trageser, president of the Association of Organ Procurement Organisations, said Wednesday that he was "cautiously optimistic" a clearer definition of these donors and organs would help encourage their use both by OPOs and by hospitals.
"If we're going to look at maximising opportunities to get people off the transplant list we've got to be sure hospitals are supporting donation, helping us to manage those medically complex donors, and transplant centres have mechanisms in place where they can make use of those," he said.
CMS officials didn't respond when asked if similar requirements were planned for transplant centres or donor hospitals.
Strengthening Safety Standards and Public Confidence
Among other steps in the proposed rule are new definitions of what constitute "unsound medical practices" for organ-handling and patient safety, criteria that CMS uses in regulating and certifying organ groups.
Those are in addition to other safeguards being adopted by OPOs and under consideration by another government agency after some rare but scary reports of patients prepared for organ retrieval despite showing signs of life. Those planned retrievals were stopped but they shook public confidence, prompting thousands of people to remove their names from donor lists last year.
The proposed rules represent a significant step forward in addressing both the critical shortage of transplant organs and the need to maintain public trust in the donation system. By creating clearer guidelines for medically complex organs and strengthening oversight mechanisms, CMS aims to save more lives while ensuring the highest standards of medical practice are maintained throughout the organ donation and transplantation process.
