Increases in Organ Donation in Donor Hospitals Changing Organ Procurement Organization Affiliations

ImportanceDonor hospitals in the United States are assigned to a designated organ procurement organization (OPO) responsible for managing deceased donors in the designated donation service area (DSA). Donor hospitals can apply for waivers to work with a different OPO with appropriate justification, and beginning with the 2026 OPO certification cycle, the highest-performing OPOs can bid to work with donor hospitals managed by intermediate- and low-performing OPOs. ObjectiveWe sought to evaluate the impact of donor hospital waivers on organ donation activity. DesignRetrospective cohort study. SettingWe evaluated Organ Procurement and Transplantation Network (OPTN) data from two OPOs (Donor Network West and Honor Bridge), each with a donor hospital (Renown Regional Medical Center and North Carolina Baptist Hospital) in its DSA granted a waiver to work with a different OPO beginning in April 2025. Main OutcomeWe assessed changes in the number of organ donors and organs transplanted pre- and post-granting of a waiver using a difference-in-differences approach based on multilevel mixed-effects models. ResultsAfter switching OPO affiliations, these two donor hospitals had marked and statistically significant increases in the number of donors recovered and organs transplanted, despite stable numbers of reported deaths at each hospital. In multivariable models, switching OPO affiliations was associated with a statistically significant increase in donors recovered and organs transplanted. Conclusion: With eight months of post-waiver data, donor hospitals with granted waivers had significant increases in donation activity driven by improved donor conversion rather than changes in referral patterns or organ yield per donor. Although longer-term data are needed to confirm these findings, CMS and the organ transplant community should feel confident that changing donor hospital-OPO affiliations will not negatively impact donation and may lead to significant increases in donation. These data also counter unfounded concerns that the continued granting of waivers and realignments of donor hospital-OPO affiliations during the 2026 recertification cycle will lead to a collapse of the system of organ donation. KEY POINTSO_ST_ABSQuestionC_ST_ABSDo donor hospitals who request a waiver to change OPO affiliations have changes in organ donation rates? FindingsUsing a difference-in-difference approach, the two donor hospitals who changed OPO affiliations had a significant increase in organ donors and organs transplanted after being granted a waiver. MeaningDonor hospitals that change OPO affiliations have an immediate increase in organ donation activity.