Each year, the individuals and organizations in the U.S. organ donation, procurement, allocation, and distribution system work together to provide transplants to many thousands of people, but thousands more die before getting a transplant due to the ongoing shortage of deceased donor organs and inequitable access to transplant waiting lists. Realizing the Promise of Equity in the Organ Transplantation System, a new consensus study report from the National Academies of Sciences, Engineering, and Medicine's Committee on A Fairer and More Equitable, Cost-Effective, and Transparent System of Donor Organ Procurement, Allocation, and Distribution, provides expert recommendations to improve fairness, equity, transparency, and cost-effectiveness in the donor organ system.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON A FAIRER AND MORE EQUITABLE, COST-EFFECTIVE, AND TRANSPARENT SYSTEM OF DONOR ORGAN PROCUREMENT, ALLOCATION, AND DISTRIBUTION
• Reviewers
• Acknowledgments
• Preface
• Acronyms and Abbreviations
• Summary
  • ABSTRACT
  • CHALLENGES AND OPPORTUNITIES
  • RECOMMENDATIONS
  • REFERENCES
• 1. Introduction and Study Context
  • MOVEMENT TOWARD A NATIONAL SYSTEM
  • COMPLEXITY, SCARCITY, AND PUBLIC CONCERNS
  • STUDY CHARGE
  • THE NATIONAL ACADEMIES STUDY PROCESS
  • COMMITTEE APPROACH AND INTERPRETATION OF THE STATEMENT OF TASK
  • WHY IS THIS STUDY NEEDED?
  • OVERVIEW OF CHALLENGES
  • REFERENCES
• 2. The U.S. Organ Transplantation System and Opportunities for Improvement
  • EVOLUTION OF NATIONAL ORGAN TRANSPLANTATION SYSTEMS, POLICIES, AND OVERSIGHT
  • COMPLEXITY OF THE CURRENT ORGAN TRANSPLANTATION SYSTEM
  • NATIONAL GOALS TO DRIVE SYSTEMATIC IMPROVEMENT
  • DECEASED DONOR ORGAN USE AND ECONOMICS TODAY
  • INNOVATION CHALLENGES AND OPPORTUNITIES
  • REFERENCES
• 3. Foundations for a Trustworthy Deceased Donor Organ Transplantation System
  • WHY IS TRUSTWORTHINESS IMPORTANT?
  • ETHICAL PRINCIPLES AND THEORIES FOR A TRUSTWORTHY SYSTEM
  • THE RELEVANCE OF ETHICAL PRINCIPLES FOR THE ORGAN TRANSPLANTATION SYSTEM
  • TRANSPARENCY: AN INSTRUMENTAL VALUE FOR A TRUSTWORTHY SYSTEM
  • REFERENCES
• 4. Confronting and Eliminating Inequities in the Organ Transplantation System
  • PRIORITIZING HEALTH EQUITY IN THE TRANSPLANTATION SYSTEM—WHY IS THIS IMPORTANT?
  • STRIVING FOR HEALTH EQUITY AND FAIRNESS IN ORGAN TRANSPLANTATION
  • DATA CHALLENGES RELATED TO ASSESSING AND ASSURING EQUITY
  • STRUCTURAL BARRIERS TO EQUITY IN THE PATHWAY TO AN ORGAN TRANSPLANT
  • IMPROVING QUALITY AND HEALTH EQUITY ACROSS THE ENTIRE ORGAN TRANSPLANTATION SYSTEM
  • EVIDENCE-BASED INTERVENTIONS FOR IMPROVING HEALTH EQUITY IN THE ORGAN TRANSPLANTATION SYSTEM
  • REFERENCES
• 5. Saving More Lives and Enhancing Equity with Deceased Donor Organ Allocation Policies
  • DISPARITIES EXACERBATED BY ALLOCATION SCORING SYSTEMS
  • CURRENT ALLOCATION POLICIES AND SCORING SYSTEMS
  • SURVIVAL BENEFIT OF TRANSPLANTATION
  • MODELING ALLOCATION POLICY CHANGES
  • INFORMATION TECHNOLOGY INFRASTRUCTURE OPPORTUNITIES
  • REFERENCES
• 6. Improving Procurement, Acceptance, and Use of Deceased Donor Organs
  • INCREASING DECEASED ORGAN DONATION AND PROCUREMENT
  • OPO REGULATORY FRAMEWORK AND PERFORMANCE METRICS
  • KEY AREA FOR IMPROVEMENT FOR OPOS: DONATION AFTER CIRCULATORY DETERMINATION OF DEATH
  • TRANSPLANT CENTER REGULATORY FRAMEWORK AND PERFORMANCE METRICS
  • KEY AREA FOR IMPROVEMENT FOR TRANSPLANT CENTERS: ORGAN USE
  • KEY AREA FOR IMPROVEMENT FOR TRANSPLANT CENTERS: ORGAN OFFER ACCEPTANCE
  • DONOR CARE UNITS
  • REFERENCES
• 7. Measuring and Improving System Performance
  • OPTN MEASUREMENT CHALLENGES
  • DASHBOARD OF STANDARDIZED, CONSENSUS-BASED PERFORMANCE MEASURES
  • QUALITY IMPROVEMENT IN ORGAN DONATION AND TRANSPLANTATION
  • ALIGNING INCENTIVES TO MAXIMIZE ORGAN USE
  • REFERENCES
• Appendix A. Public Meeting Agendas
• Appendix B. IOM and National Academies Solid Organ Transplantation Reports
• Appendix C. Biographical Sketches of Committee Members and Staff

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2022. Realizing the promise of equity in the organ transplantation system. Washington, DC: The National Academies Press. https://doi.org/10.17226/26364.

Digital Object Identifier: https://doi.org/10.17226/26364

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