Organ Procurement Organizations Advance Project Improving Performance Measurement and Accountability to Save Lives
MCLEAN, Va., May 5, 2026 /PRNewswire/ -- Today, the Association of Organ Procurement Organizations (AOPO) announced the submission of new performance metrics designed to more accurately measure organ procurement organizations (OPOs) and strengthen accountability across the U.S. organ donation system.
Four independently validated measures were submitted for endorsement to the Partnership for Quality Measurement, the consensus-based entity contracted by the Centers for Medicare & Medicaid Services (CMS) to review health care measures. This marks an important milestone in an ongoing project led by AOPO in partnership with 53 OPOs representing the vast majority of the nation's donation system and Econometrica, Inc.—a nationally recognized health policy research firm—to improve transparency and ensure performance is evaluated using data that reflect the realities of an OPO's work to save lives.
The validated measures were developed using CMS' own Blueprint Measure Lifecycle framework and are grounded in the Donabedian Model, a widely accepted approach to evaluating health care quality. These measures represent the first phase of a broader effort to create a comprehensive, data-driven framework for OPO performance. They reflect the parts of the donation process for which OPOs are directly responsible, helping align accountability with operational control and address unintended challenges introduced by CMS' OPO Final Rule.
Under the current Final Rule, nearly half of all U.S. OPOs, which serve up to 72% of the U.S. population, will face automatic decertification or forced competition for their service areas in late 2026. The level of nationwide disruption this would cause is unprecedented in health care regulation, highlighting the urgent need for accurate, actionable performance measures to protect the more than 100,000 patients currently awaiting lifesaving transplants.
The Final Rule uses two outcome metrics to measure OPO performance: donation rate and transplant rate. OPOs in the top 25th percentile are recertified, those above the median but below the top 25th percentile must compete to retain their service areas, and those below the median on one or both measures are automatically decertified. While OPOs play a critical role in facilitating donation, they do not control whether recovered organs are ultimately accepted and transplanted, as those decisions are made by transplant centers.
A growing body of research has identified critical limitations preventing the OPO Final Rule's two metrics from accurately measuring OPO performance. These include exclusive reliance on outcome measures that not only are statistically flawed, but also use a relative ranking system that places some OPOs at risk of closure regardless of performance improvement while ignoring critical issues in others.
"We cannot improve this lifesaving system if we do not measure it accurately," said Econometrica Health Practice Area Director, Dr. Jean O'Connor. "Oversight must be grounded in precise measures that reflect the role each stakeholder plays in the overall system."
In order to provide a more accurate evaluation of OPO performance, the four validated measures submitted by AOPO focus on the foundational stages of the donation process:
- Referral rate: Rate of hospital referrals of potential organ donors made to the OPO from within the OPO's donation service area in a calendar year.
- Approach rate: Rate of referred patients that are approached for an organ donation in the OPO's donation service area in a calendar year.
- Authorization rate: Authorization rate for organ donation among approached, referred potential organ donors in the OPO's donation service area in a calendar year.
- Donation rate: Rate of the number of organ donors to the potential donors in an OPO's donation service area in a calendar year.
These four are the first submissions from a broader set of measures, with additional measures focused on donor management, organ yield, utilization, and patient safety expected later this year.
By adopting these independently validated performance measures, CMS can align stakeholder accountability and allow critical improvements to be made without risking the donation system's stability or continuity.
"Countless donors, patients and their families are depending on regulators and the donation community working together to protect this delicately complex system," said AOPO President Jeff Trageser. "Today's submission supports the growing need for refined performance measures and the alignment of regulatory goals across the system to ensure every donation opportunity is maximized and more lives can be saved."
Each person who becomes an organ, eye, and tissue donor can save up to eight lives and heal more than 75 people. AOPO encourages everyone to learn more and consider signing up as a donor. You can register today by visiting RegisterMe.org/AOPO50K.
About the Association of Organ Procurement Organizations (AOPO)
AOPO leads the nation's organ donation community to save and improve lives through organ, eye, and tissue donation. Founded in 1984, AOPO advances organ donation and transplantation by driving continual improvement of the donation process, collaborating with stakeholders, and sharing successful practices with its 47 member OPOs. AOPO envisions a future where every opportunity for donation results in lives saved. For more information about this project, please visit www.aopo.org/opo-metrics-project.
About Econometrica, Inc.
Econometrica is a small business management and technical consulting organization with more than 25 years of experience supporting state, federal, and private clients in solving complex challenges through data analytics, health policy expertise, and quality measurement development. AOPO retained Econometrica to provide measure development support.
Contact Information:
Jenny Daigle | [email protected]
SOURCE Association of Organ Procurement Organizations
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