One donor may provide organs to several different patients. 1). 3. Organ donation among minority populations, however, has increased over time. 2.) Of these OPOs, adjacent OPOs took over the service areas of two and a portion of the third’s. The fourth OPO merged operations with another OPO, and the fifth, determined to be a new entity, was exempt from meeting the performance standard. HCFA’s Current Standard Is Not the Best Measure of OPO Performance

HCFA’s current standard does not accurately measure OPOs’ performance in procuring organs usable for transplantation for several reasons. These characteristics vary by region and by OPO and can pose advantages or disadvantages to an OPO’s ability to procure donors. Although the affected OPOs are to consider their total populations and agree on population adjustments, OPOs did not account for about 2.1 million people in their population data. Adjusting for Cause of Death and Age More Accurately Estimates Number of Potential Donors Than Number of Deaths Alone

Measuring OPO performance according to the number of service area deaths adjusted for cause of death and age more accurately reflects the number of potential donors than measuring performance according to the number of all service area deaths. Again, this may be less problematic when HCFA moves to a 4-year recertification cycle. To assess the OPOs using these alternative measures, we used the 1994-95 OPO data on the categories HCFA used to assess performance. Five OPOs would have been subject to termination for failing to meet at least 75 percent of the national average for at least three of the five performance categories using HCFA’s population-based standard; three of these five OPOs would also have failed using a standard based on the number of deaths or adjusted deaths. An Alternative Standard Using Medical Records Reviews Would More Accurately Determine the Number of OPOs’ Potential Donors but May Be Costly

A standard using the number of donors and the number of organs recovered and transplanted compared with the number of potential organ donors would more accurately assess OPO performance. In addition, the degree to which added expense will be incurred to conduct the reviews and analyze the results is not clear. HCFA’s current population-based performance standard cannot accurately assess OPOs’ ability to meet the goal of acquiring all usable organs because it does not identify the number of potential donors within the OPOs’ service areas. We identified performance measures as alternatives to the current population-based standard. Two other alternative measures that HCFA did not consider—medical records reviews and modeling—show more promise for accurately identifying the number of potential donors. Although most OPOs are conducting some form of medical records reviews and therefore incurring the costs of these reviews, HCFA must consider its own and the OPOs’ additional expense involved in standardizing such reviews. At least one group is developing a modeling method using substitute measures to provide a valid measure for estimating the number of potential donors. Recommendations

To better ensure that HCFA accurately assesses OPOs’ organ procurement performance and that OPOs are maximizing the number of organs procured and transplanted, we recommend that the Secretary of Health and Human Services direct HCFA to evaluate the ongoing development of methods for determining the number of potential donors for an OPO. We interviewed officials and obtained documentation from the Health Care Financing Administration (HCFA) and the Health Resources and Services Administration’s Division of Transplantation.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed whether the Health Care Financing Administration's (HCFA) population-based standard appropriately measures the extent to which organ procurement organizations (OPO) are maximizing their ability to identify, procure, and transplant organs and tissue, focusing on: (1) the strengths and weaknesses of the current standard; and (2) alternatives to the current standard.

What GAO Found

GAO noted that: (1) HCFA chose a population-based standard to assess OPO performance after considering the availability and cost to the OPOs of obtaining and analyzing various types of data; (2) when HCFA first applied this standard in 1996, five OPOs were subject to action for failing to meet the standard; (3) this resulted in two OPOs' service areas being taken over by adjacent OPOs, a portion of one OPO's service being taken over by an adjacent OPO, and the merger of one OPO with another; (4) the fifth OPO that failed the standard was determined to be a new entity and not subject to meeting the performance standard; (5) HCFA's current population-based standard, however, is not an accurate measure for assessing OPO performance because OPO service areas consist of varying populations; (6) although potential organ donors share certain characteristics, including causes of death, absence of certain diseases, and being in a certain age group, OPO service area populations have generally differing characteristics; (7) thus, the number of potential organ donors may vary greatly for OPOs serving equally sized populations; (8) GAO ranked the OPOs, using 1994-95 OPO procurement and transplant data, according to three measures--population, number of deaths, and adjusted deaths; (9) although three OPOs would not qualify for recertification under any of these measures, the number of and which OPOs would not qualify vary depending on the measure used; (10) HCFA did not consider two alternative measures--medical records reviews and modeling--that show promise for determining OPOs' ability to acquire all usable organs; (11) consistently applied and uniform reviews of hospital medical records with verifiable results may accurately assess the number of OPOs' potential donors; (12) because most OPOs already conduct some records review, any added expense and increase to the cost of organs may be negligible; (13) the cost of producing independently verified estimates of the number of each OPO's potential donors may be substantial, however, and the expense and impact on OPOs and organ cost must be considered; (14) though not yet fully developed, a modeling approach using substitute measures to determine the number of potential donors may be less expensive and easier to execute; (15) unless OPO performance is measured according to the number of potential donors, HCFA cannot determine OPOs' effectiveness in acquiring organs; and (16) the measures GAO has identified provide alternatives for HCFA to pursue to more accurately assess OPO performance.