Organ procurement organizations (OPOs) have been exploiting taxpayers for decades — NHL and NFL season tickets, board meetings in California wine country, private jets chartered for organ delivery but hijacked for CEO jaunts — all while failing to do what they’re supposed to do: procure organs for needy patients.
During a virtual hearing Tuesday, Rep. Raja Krishnamoorthi (D-Ill.), chair of the Subcommittee on Economic and Consumer Policy, brandished what he said was the 2019 financial statement of the Nevada Donor Network and demanded that Joe Ferreira, head of the network and president of the Association of Organ Procurement Organizations (AOPO), explain the $6 million the network spent on “administrative and general expenses.” These included more than $140,000 for travel, meetings, and seminars, as well as over a half a million in unexplained expenses.
Krishnamoorthi also questioned Ferreira about his network’s season tickets to Las Vegas Golden Knights and Raiders games, as well as board retreats to Napa Valley and Sonoma Valley. Ferreira confirmed each expense one by one, but offered no additional comment on them.
Rep. Katie Porter (D-Calif.) brought up a separate incident where an OPO CEO used a jet intended for organ collection to take a vacation.
“That literally happened,” she said. “This is not a hypothetical story with the jet.”
Each of these expenses “have nothing to do with recovering organs for ailing and dying patients on the organ transplant list,” Krishnamoorthi said.
On Taxpayers’ Tab
Medicare is responsible for all OPO costs — not OPO “extravagance” — and those costs are paid by taxpayers, said Krishnamoorthi, who informed Ferreira, along with a second witness, Steve Miller, AOPO CEO, that he would direct his committee to call on the organization to provide 5 years of itemized general and administrative expenses.
He also called attention to a report from the Project on Government Oversight that found that the AOPO was intentionally delaying Congress’s probe of the industry.
Krishnamoorthi read from an email that described a phone call that Ferreira participated in mid-January. Legal counsel recommended OPOs send Congress “‘slow and incomplete answers,'” to its inquiries, in the hope that “‘his team [Krishnamoorthi, according to the chair] gets distracted and moves on.'”
“Mr. Ferreira…you don’t think I’m going to be moving on from this investigation, do you?” Krishnamoorthi asked. Ferreira responded in the negative.
Krishnamoorthi stressed that he would continue to work to see that OPOs, and the AOPO, “live up to the standards that they should live up to” and stop wasting Medicare dollars.
Gaming the System?
During the hearing, Porter took out a mini-whiteboard to illustrate how OPO metrics allowed them to game their performance ratings, by undercounting the number of eligible deaths and eligible donors, making their rates of donation appear better than they were.
In 2019, the Trump administration proposed two rules aimed at increasing kidney donation by replacing self-reported measures with more objective performance standards, and by calling on all OPOs to meet the donation and transplant rates of the top performing quartile of OPOs. According to subcommittee ranking member Rep. Michael Cloud (R-Texas), the Biden administration reissued the final rule around organ procurement about a month ago.
The AOPO lobbied against those rules with concerns about “flaws in the design” and a “flawed dataset.”
But leaked emails, along with information from a whistleblower, suggest that the organization may have tried to intentionally obstruct increased oversight.
Porter asked Miller how he could have defended such weak metrics and opposed more objective standards.
Miller argued that the AOPO had called for “improvements to the new metrics. We were not lobbying against the new metrics.”
Broken and Unaccountable
Whistleblower Matthew Wadsworth is currently the CEO and president of an OPO, Life Connection of Ohio. He said he was so disgusted by the AOPO leadership for their “anti-accountability” stance that, as of Tuesday, he and five other OPO CEOS were withdrawing their membership.
Wadsworth, who is a former Nevada Donor Network executive, stated that “We’ve turned the organ donor waiting list into The Hunger Games, a deadly arena of our own making in which we watch 33 Americans die every day.”
He lambasted the system as “broken … grossly inefficient, and unaccountable.”
He also noted that because of poor regulation, no OPO has lost a government contract for poor performance issues in nearly 40 years. “Simply put, there’s been no consequence to OPOs for allowing patients to die,” he stated.
Wadsworth proudly pointed out that Life Connection of Ohio, which he has led since January 2020, is now on track to nearly double organ recovery in its service area.
“Leadership matters,” he stressed.
Finally, he stated that the CEOs who are leaving the AOPO have committed themselves to the principles of “transparency, accountability, and patient-centric performance improvement.”
Two patients awaiting transplants — both Black women — spoke at the hearing.
Tonya Ingram, age 29, is a Los Angeles-based poet and mental health advocate who was diagnosed with end-stage kidney failure in 2018. Because of her rare blood type, it may be 10 years before she can get a new kidney, she said.
LaQuayia Goldring, age 31, spoke from inside a noisy dialysis clinic. She lost her left kidney to childhood cancer and underwent a transplant after going into renal failure at age 17. At age 25, she went into complete renal failure.
“I can’t miss dialysis — ever,” she said, explaining that she gets dialysis 3 days a week. Sometimes she has to be carried into her home after treatment because she is too weak to walk, she added.
“The longer I wait for a kidney, the longer I feel like my life is hanging in the balance,” she said.
Rep. Hank Johnson (D-Ga.) pointed out that Black Americans are three times more likely to have kidney failure, but are less likely to be identified as candidates for transplants; less likely to be added to waiting lists; and receive lower quality organs when they do get them.
“OPOs are failing people of color at every step in this process and the numbers show it,” Johnson said.
He pointed to federal data that found white Americans on a transplant waiting list have a 50% chance of receiving an organ annually, while Black Americans have a roughly 25% chance.
Donna Cryer, president and CEO of the Global Liver Institute, affirmed that multiples studies have shown racial bias against African Americans, Latinx Americans, and Asian-Pacific Islanders at every level of the transplant system.
Cryer mentioned the importance of having diversity among OPO staff: “Having people of color approaching families of color results in more donations.”
Rep. Ayanna Pressley (D-Mass.) said that white families of potential donors are approached at twice the rate of Black families, and argued that OPO data regarding how well staff engage with families of color — which families are approached and which are ignored with regard to donation — should be made available.
Cryer also pointed out that prior to the new rules, OPOs that self-reported their success rates may have said there were no families of color available to engage, but as more objective standards are implemented “that can’t happen.”
‘Room to Improve’
In an opening statement, Ferreira argued that there are “misconceptions” about OPOs, including that the organizations are individually responsible for organ procurement.
He stated that OPOs are “intermediaries” and “their success is highly dependent on collaborations with hospitals and transplant programs.”
Hospitals have the job of notifying OPOs “in a timely manner” when a patient meets the criteria for organ donation, and transplant centers are responsible for making the decision as to whether to accept or decline an organ, he said.
He spoke about the “sustained incremental growth” of the transplant system, but acknowledged that it “has room to improve.”
Ferreira said that the AOPO is making efforts to reform from within, including launching a campaign that will deliver 50,000 organ transplants annually by 2026; increase collaboration; reduce inequities; maximize organ utilization; and increase innovation and research.
Last Updated May 05, 2021
Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow
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