Editor's Note: This article has been edited to clarify that LifeCenter NorthWest is not among the organ procurement organizations being investigated by a House committee.
During the start of the COVID-19 pandemic, organ transplants plummeted by half. Though there was an increase in deceased donors in 2020 from the year before, there were fewer living donors, possibly explained by the postponement of elective surgeries.
In 2021, however, the rate recovered and the U.S. reached a record number of transplants, at more than 41,300, though a significant waitlist for organs remains and may grow; experts expect there may grow a significant demand for kidney transplants in the years to come due to COVID.
Fierce Healthcare spoke to the nonprofit that manages the U.S. transplant system, United Network for Organ Sharing (UNOS), and an organ procurement organization (OPO), as well as dove into the latest national data on donors, waitlists and hospitals.
There has generally been a steady rise in donors and transplants for more than a decade, but UNOS was not expecting to achieve a record increase last year, given the current public health crisis—the achievement was “remarkable,” said Brian Shepard, CEO of UNOS. UNOS is under investigation by the Senate Finance Committee and is a named defendant in recent litigation involving a controversial new policy of organ procurement.
Deceased donors once infected with COVID could still be used in certain cases, but not if they were infected at the time of death, Shepard said. Organs from COVID-infected donors only made up 1% of all transplants last year. Meanwhile, just under 16% of transplants came from living donors in 2021.
Families who receive heavy news about a loved one’s condition in a hospital are typically first approached by an organ procurement organization, explained Nettie Jensen, a donation and family advocate at LifeCenter NorthWest, an OPO in Seattle. “We are in front of these families at, always, the most tragic point in their life,” she said.
Of note, some OPOs are under investigation by a House committee, though LifeCenter NorthWest is not among that group, it said.
But the pandemic “was like hitting a brick wall” in terms of connecting face to face with families. Workers in this role had to learn to build trust by phone or over Zoom with families or help families grieve outside on the curb instead of in the hospital, where many were not allowed inside during the peak of the pandemic.
Since OPO staff are allowed in hospitals, Jensen explained, they could be there with someone’s loved one when their family could not. They did FaceTime calls with families from inside, and engaged in memory-making, or providing families with things like quilts with their loved one’s handprint on them. “It’s like wrapping them in love from their person,” Jensen said. While this technique predated COVID, normally, families could be present for the memory-making.
Apart from having to think outside the box when it comes to family engagement, LifeCenter NorthWest wanted to do more work in diversity, Jensen said. The OPO started a workgroup last year focused on diversity, equity and inclusion. Mandatory for staff is compassionate conversation training, which takes place in practice sessions with actors of color.
According to UNOS data viewed by Fierce Healthcare, Methodist Specialty and Transplant Hospital in Texas oversaw the most transplants that came from living donors in 2021, followed by the University of California-San Francisco Medical Center. Mayo Clinic Hospital Arizona had the most transplants that came from deceased donors that year, followed by the University of California-Los Angeles Medical Center.
California currently has the biggest waitlist for organs, with more than 20,500 candidates listed, of whom most (45%) are Hispanic. Texas has the second-biggest waitlist, with nearly 10,000 candidates, most of whom (43%) are also Hispanic. New York follows with the third-biggest waitlist, with more than 8,400 on the list, most of whom are white (34%) and Black (33%).
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More than other ethnicities, white people made up the greatest portion (65% or more) of deceased donors over the past several years. In eight states, 90% or more of deceased donors were white in 2021. States and territories with the highest shares of Black deceased donors included D.C., Mississippi, Maryland, Louisiana and Alabama. Those with the highest shares of Hispanic deceased donors included New Mexico, California and Texas.
Both Jensen and Shepard attributed the rebound in transplants last year to a renewed commitment to teamwork.
“Many, many hands touch a donor case,” Jensen said. “We have multiple levels of people that are working to really determine whether a person is suitable—a lot goes into making a donation happen.”
Shepard stressed that the hospitals and organizations involved don’t act as competitors, but rather constantly communicate with one another and share vital data to keep the process streamlined.
“Because of that kind of collaboration we were really able to right the ship quickly and save lives,” Shepard said.