In their letter to the inspector general, Sens. Charles E. Grassley (R-Iowa) and Todd C. Young (R-Ind.) praised the proposed regulations but pointed out that it will be years before they take effect. In the meantime, they said, Americans are dying each day as they wait for organ transplants and more action should be taken now.
More than 114,000 people are on waiting lists for kidneys, livers, hearts and other organs. Thirty-three of them die each day, and many wait for years.
Grassley, the Finance Committee chairman, said in a statement that “more can be done right now to improve a system that is mired by inefficiency, waste and a serious lack of accountability.”
Grassley and Young asked the inspector general to determine whether there are adequate safeguards to ensure that federally funded organ procurement organizations (OPOs) are using taxpayer money on their primary mission: recovering organs for transplant.
Some OPOs have transferred millions of dollars to foundations they’ve established, which have paid for such things as jets, parties and parade floats, the groups’ Internal Revenue Service records show. The senators pointed to a 2013 inspector general report that identified such questionable spending and asked whether any audits have been conducted since then.
“To ensure that OPOs are focused on achieving their mission of organ recovery, regular fiscal oversight is necessary,” they wrote.
There are 58 OPOs across the nation, each with exclusive responsibility for recovering organs in its assigned region. The groups have contracts with the Centers for Medicare and Medicaid Services, which reimburses them for the costs of recovering organs and delivering them to hospitals for transplant.
The senators also asked the inspector general whether it has ever audited the United Network for Organ Sharing (UNOS), which they said runs the transplant system as a “monopoly.”
UNOS has held the government contract since the network was established in 1986. It acts as a clearinghouse for organs, coordinating the complex system that speeds them from hospitals where they are procured to others where they are transplanted.
In making its case for greater oversight of the system, the senators cited articles and an analysis conducted last year by The Washington Post, saying they exposed “a need for more rigorous oversight by Congress and the OIG.”
The Post analysis found that as many as 27,000 people met the criteria in 2016 for organ donation, a total that would have yielded more than twice the number of organs that were actually recovered that year. The articles also exposed problems with how OPO performance is evaluated. The organizations self-report their organ recovery data, which is not independently assessed and is easily manipulated.
At a recent news conference, Trump administration officials said if the proposed regulation is finalized, the number of potential donors and the number of transplantable organs for each OPO would be independently checked.
If the new performance standards were applied to the organizations today, 37 of 58 would be out of compliance, federal records show.
The proposed regulations, which would take effect in 2022, could increase the number of organs available for transplant annually from about 36,000 to 42,000 by 2024.
In a statement Tuesday, the Association of Organ Procurement Organizations, the industry’s trade group, said: “We look forward to working with CMS on implementation of the rule and ensuring the metric is used to drive the changes everyone in the donation and transplantation community wants to see.”
Jennifer Erickson, a former Obama administration staffer who led efforts to overhaul the organ transplant system, welcomed increased oversight from Congress and the inspector general.
“OPOs have operated without accountability for decades, and hundreds of thousands of patients have died waiting for a transplant as a result,” she said. “Congress has a responsibility to make sure that government contractors are doing their jobs effectively and acting in the best interest of patients and families in their states.”