Former U.S. Representative and surgeon Dr. Larry Bucshon is raising alarms about a federal policy he says threatens the nation's organ donation and transplantation system. Bucshon, who helped pass the Securing the Organ Procurement and Transplantation Network Act, argues that upcoming regulatory changes by the Centers for Medicare and Medicaid Services (CMS) could destabilize the infrastructure that saves thousands of lives annually.
The U.S. system, widely regarded as the world's best, relies on a delicate balance among donor hospitals, transplant centers, and organ procurement organizations (OPOs). Bucshon describes this as a "three-legged stool" where each component depends on the others. If one leg falters, the entire system—and the over 100,000 patients waiting for transplants—suffers.
Later this year, CMS is set to enforce a 2020 final rule that could shut down or force competition on dozens of OPOs, affecting up to 72 percent of the country. The rule redefines performance metrics using donation and transplant rates, but Bucshon argues these measures are deeply flawed. OPOs control donation coordination, not transplant acceptance—those decisions rest solely with transplant centers. Federal regulations also discourage centers from accepting organs from medically complex donors, leading to thousands of viable organs going unused annually.
Research since the rule's introduction has highlighted systemic issues: the metrics don't account for state-level public health disparities, rely on outdated two-year-old data, and use relative rankings. This means a fixed share of OPOs will always fall below the median, regardless of actual performance improvements. "This approach is unprecedented in federal healthcare quality programs," Bucshon noted, where providers are typically measured against objective benchmarks, not against each other.
Bucshon warns that if unchanged, the rule will reduce donors and increase deaths among transplant candidates. He urges CMS to implement a phased transition period to protect system continuity while developing more accurate performance measures. OPOs have been working with healthcare analytics firm Econometrica, Inc. to create independently validated metrics using CMS's own framework, aiming to ensure accountability without destabilizing the system.
The political stakes are high, as the debate touches on broader healthcare policy challenges. For context, recent stories like Cigna's exit from ACA exchanges highlight the fragility of market-based healthcare solutions. Meanwhile, lawmakers are grappling with other regulatory battles, such as closing loopholes in crypto fraud oversight.
Bucshon praised CMS Administrator Dr. Mehmet Oz for meeting with stakeholders to discuss solutions, calling constructive engagement essential. He urged all legislators to connect with local OPOs and understand the complexities of donation work. "We have the world's best donation and transplant system," he said. "Although there is always room for improvement, we must ensure changes don't undo the progress that has allowed OPOs and hospitals to save over a million lives."
