What you don’t know about organ donation could save lives

Although there are 155 million registered donors — or nearly half of US adults — transplant waitlists remain long. While the US leads the world in deceased organ donation rates with steady growth and clinical innovations that have helped address the need, there is major room for improvement.

With the right systemwide interventions, deceased donor kidney transplantation could jump by 61% by 2026, says Alex Glazier, CEO of New England Donor Services. A key challenge for this community is the fact that there is a substantial underutilization of the available, albeit less than perfect, organ supply. For example, over 20% of donated kidneys that have been recovered surgically, prepared, and offered for transplant ultimately are not used. Even more surprising, a study found that patients who died waiting for a kidney transplant received a median of 16 kidney offers over 651 days, declined by their transplant program. Alex says given a system of scarcity, understanding the risk-benefit of accepting a less than perfect organ and being transplanted must be assessed against the very real possibility of receiving no transplant at all.

To learn more about the challenges and opportunities for organ donation, Dan Shellenbarger, partner in Oliver Wyman’s Health and Life Sciences Practice, sat down with Alex and Kevin O’Connor, CEO of LifeCenter Northwest on the Oliver Wyman Health Podcast to talk about ways in which their organizations are driving improvements in organ recovery and transplantation and why older donors are a key demographic of focus.

Key talking points:

• Despite nearly half of US adults being registered donors, transplant waitlists remain long, with many patients dying before receiving an organ.
• A significant share of viable organs goes unused, with more than 20% of recovered kidneys ultimately not transplanted due to system inefficiencies and risk aversion.
• Small improvements in utilization rates and better coordination across the donation-to-transplant process could meaningfully increase the number of transplants.
• Expanding the use of organs from older donors represents a major opportunity, especially since outcomes are often better than remaining on waitlists.
• Shifting incentives and decision-making toward patient-centered outcomes could help programs accept more “imperfect” organs rather than waiting for ideal matches.

This episode is part of the Oliver Wyman Health podcast series, which includes conversations with leaders pioneering healthcare market transformation.

Subscribe for more on: Apple Podcasts | Spotify | Youtube

This episode was first broadcast in August 2021.

Alex Glazier

We look at kidney transplant, in particular. They’ve grown at a rate of roughly 6.7% each year since 2013, and that’s remarkable. Yet we still have approximately 108,000 patients waiting, and we have patients who die waiting. We know that as good as our system is, there is more that can and needs to be done.

Narrator

That’s Alex Glazier, CEO of New England Donor Services, here, along with Kevin O’Connor, CEO of LifeCenter Northwest, to talk about the current state of organ donation and recovery in the United States. She’ll also discuss opportunities for all healthcare stakeholders in the industry.

The Oliver Wyman Health Podcast, brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.

Dan Shellenbarger

Hello, and welcome to the Oliver Wyman Health podcast. I am joined by Alex Glazier, the CEO of New England Donor Services, and Kevin O’Connor, who is the CEO of LifeCenter Northwest. I’ve gotten to know Alex and Kevin over the last year as we discussed and debated ways to drive improvement in organ recovery and transplantation. That’s the topic of our conversation today, which I’ve come to realize presents many opportunities and highlights the vital importance of this very, very, very important service. Kevin, Alex, thank you.

I was amazed. I thought organ donation or recovery was just a system that takes care of itself from here. But as we got into the discussion, I learned — holy smokes — that’s not at all how it works. In fact, there’s been a substantial amount of progress over the last several decades. Talk to us a little bit about where we’ve been and what we’ve already accomplished when it comes to organ recovery and transplantation.

You might assume, you know, you sign your donor card, and then it just happens. But the system is far more complex than that. One thing that surprises many is that the medical opportunity for organ donation is actually quite rare — only about 2% of deaths in hospitals have any potential for organ donation. That means each opportunity is incredibly precious, and the system needs to do its best to realize those opportunities to serve the patients waiting. The system doesn’t work quite well enough, and we still aren’t meeting the needs.

Alex

To put it in perspective, we have about 155 million registered donors, which is roughly 50% of the population. We also have a legal framework that allows families — or surrogates — to make the decision if the patient hasn’t registered. That gives us two opportunities to get to “yes.” But once we have permission and some medical suitability, a lot needs to happen to manage donors medically to maximize transplant potential, and then to surgically recover the organs and ensure they are utilized by the programs with patients waiting.

Each of those steps is highly interdependent. And, as you pointed out, the growth has been significant — over 50% increase in deceased organ donation in the US and roughly 6.7% annual growth in transplants since 2013. That’s remarkable. Yet, we still have about 180,000 patients waiting, and some die waiting. We know there’s more that can and should be done to optimize this process.

Dan

Unpacking the system and the levers of change that could lead to improvements is critical. What are some of the key changes that have occurred, or that could unlock further progress?

Alex

The donation-to-transplantation process is incredibly complex. It begins with identifying a potential donor in a hospital. Donor hospitals need to improve their ability to identify and refer potential donors in a timely fashion to organ procurement organizations (OPOs). We’ve seen substantial improvements there.

Then, OPOs respond and work to respond quickly and capitalize on every potential donation opportunity. We’ve also introduced innovative approaches to surgical recovery and organ preservation, which help us evaluate organs that might have previously been deemed unsuitable. These advances have opened new opportunities to use organs more effectively.

Kevin O’Connor

Many transplant programs in the US are working hard to increase capacity and improve their ability to utilize the increasing number of organs available. However, a major challenge remains — the underutilization of available organs. For example, over the past five years, more than 20% of recovered kidneys have not been transplanted. Last year, in 2020, over 5,000 kidneys recovered were not transplanted, which is a huge missed opportunity.

Dan

Kevin, you mentioned LTL earlier. We should clarify that LTL is the abbreviation for LifeCenter Northwest, which is a nonprofit organization designated by the federal government to serve a specific geographic area. They coordinate organ donation and transplantation from potential donor identification all the way through to transplantation. The process is a complex labyrinth, and many stakeholders work hard to make it happen. No one wants to see an opportunity missed. Looking ahead, there’s a lot of potential. What areas should we focus on?

Alex

One key area for growth is in older donors. Ensuring organs from donors over 60 are recovered and effectively utilized is crucial. The system needs to work together across its components to realize these results. It’s not just about recovering more organs from older donors but actually transplanting them to benefit patients.

We need to address barriers and incentives to improve utilization. For example, the report found that, with modest improvements, we could increase kidney transplants by about 2,000 annually — moving from roughly 28,000 to over 30,000 transplants per year by 2026.

Kevin

Currently, about 80% of recovered kidneys are transplanted, but 20% are not. Moving that to 84% would mean roughly 1,070 additional transplants annually. Small percentage increases in utilization, combined with increased recovery from older donors, could significantly impact the number of transplants.

These incremental improvements need to happen in coordination. If one component improves in isolation, the full potential isn’t realized. All parts of the system must align with success metrics, regulatory and financial incentives, and disincentives to maximize organ utilization.

Dan

What about the broader cultural and policy shifts needed?

Alex

We need to rethink metrics. For example, the current focus on one-year graft survival constrains programs’ willingness to push boundaries. Major societies are working on new metrics that emphasize longer-term outcomes, which could encourage more aggressive utilization of organs.

Also, there’s a huge opportunity to increase donation from older donors. European countries like France and the UK have higher average ages for donors — around 50 to 60 — compared to the US, where the average is around 35 to 40. We could increase the number of patients who die in a manner that makes them potential donors.

Kevin

Many patients awaiting kidneys are over 60, and outcomes from organs from older donors are often better than no transplant at all. Shifting the narrative to focus on patient-centered outcomes could help us better utilize available organs.

Additionally, transparency about organ decline reasons is limited. Improving understanding of why organs are declined could help increase utilization. For example, a study shows that patients who die waiting for a kidney receive on average 16 offers, yet many are declined, and those patients ultimately die without a transplant.

Dan

That’s a shocking datapoint. Engaging patients in discussions about organ offers and acceptance could improve outcomes. Moving toward localized recovery teams, as in the UK, could also improve efficiency and organ utilization.

Kevin

The Organ Donor Recovery Consortium is exploring establishing localized recovery teams, which have been successful in the UK. This approach could lead to better system efficiencies and higher organ utilization.

Dan

Based on these insights, what is the potential for growth in US deceased donor kidney transplants?

Alex

We could realistically see over 28,000 transplants annually by 2026 if we implement these modest but coordinated improvements. The US already has one of the best deceased organ donation systems in the world, surpassing Spain in 2020. But there’s still significant room for growth to meet the needs of all waiting patients.

Dan

It’s exciting to think about capturing this potential and making a real impact. Thank you both for your insights and efforts in this critical area.

Thanks for listening to the Oliver Wyman Health Podcast, brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.

This transcript has been edited for clarity.

Although there are 155 million registered donors — or nearly half of US adults — transplant waitlists remain long. While the US leads the world in deceased organ donation rates with steady growth and clinical innovations that have helped address the need, there is major room for improvement.

With the right systemwide interventions, deceased donor kidney transplantation could jump by 61% by 2026, says Alex Glazier, CEO of New England Donor Services. A key challenge for this community is the fact that there is a substantial underutilization of the available, albeit less than perfect, organ supply. For example, over 20% of donated kidneys that have been recovered surgically, prepared, and offered for transplant ultimately are not used. Even more surprising, a study found that patients who died waiting for a kidney transplant received a median of 16 kidney offers over 651 days, declined by their transplant program. Alex says given a system of scarcity, understanding the risk-benefit of accepting a less than perfect organ and being transplanted must be assessed against the very real possibility of receiving no transplant at all.

To learn more about the challenges and opportunities for organ donation, Dan Shellenbarger, partner in Oliver Wyman’s Health and Life Sciences Practice, sat down with Alex and Kevin O’Connor, CEO of LifeCenter Northwest on the Oliver Wyman Health Podcast to talk about ways in which their organizations are driving improvements in organ recovery and transplantation and why older donors are a key demographic of focus.

Key talking points:

• Despite nearly half of US adults being registered donors, transplant waitlists remain long, with many patients dying before receiving an organ.
• A significant share of viable organs goes unused, with more than 20% of recovered kidneys ultimately not transplanted due to system inefficiencies and risk aversion.
• Small improvements in utilization rates and better coordination across the donation-to-transplant process could meaningfully increase the number of transplants.
• Expanding the use of organs from older donors represents a major opportunity, especially since outcomes are often better than remaining on waitlists.
• Shifting incentives and decision-making toward patient-centered outcomes could help programs accept more “imperfect” organs rather than waiting for ideal matches.

This episode is part of the Oliver Wyman Health podcast series, which includes conversations with leaders pioneering healthcare market transformation.

Subscribe for more on: Apple Podcasts | Spotify | Youtube

This episode was first broadcast in August 2021.

Alex Glazier

We look at kidney transplant, in particular. They’ve grown at a rate of roughly 6.7% each year since 2013, and that’s remarkable. Yet we still have approximately 108,000 patients waiting, and we have patients who die waiting. We know that as good as our system is, there is more that can and needs to be done.

Narrator

That’s Alex Glazier, CEO of New England Donor Services, here, along with Kevin O’Connor, CEO of LifeCenter Northwest, to talk about the current state of organ donation and recovery in the United States. She’ll also discuss opportunities for all healthcare stakeholders in the industry.

The Oliver Wyman Health Podcast, brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.

Dan Shellenbarger

Hello, and welcome to the Oliver Wyman Health podcast. I am joined by Alex Glazier, the CEO of New England Donor Services, and Kevin O’Connor, who is the CEO of LifeCenter Northwest. I’ve gotten to know Alex and Kevin over the last year as we discussed and debated ways to drive improvement in organ recovery and transplantation. That’s the topic of our conversation today, which I’ve come to realize presents many opportunities and highlights the vital importance of this very, very, very important service. Kevin, Alex, thank you.

I was amazed. I thought organ donation or recovery was just a system that takes care of itself from here. But as we got into the discussion, I learned — holy smokes — that’s not at all how it works. In fact, there’s been a substantial amount of progress over the last several decades. Talk to us a little bit about where we’ve been and what we’ve already accomplished when it comes to organ recovery and transplantation.

You might assume, you know, you sign your donor card, and then it just happens. But the system is far more complex than that. One thing that surprises many is that the medical opportunity for organ donation is actually quite rare — only about 2% of deaths in hospitals have any potential for organ donation. That means each opportunity is incredibly precious, and the system needs to do its best to realize those opportunities to serve the patients waiting. The system doesn’t work quite well enough, and we still aren’t meeting the needs.

Alex

To put it in perspective, we have about 155 million registered donors, which is roughly 50% of the population. We also have a legal framework that allows families — or surrogates — to make the decision if the patient hasn’t registered. That gives us two opportunities to get to “yes.” But once we have permission and some medical suitability, a lot needs to happen to manage donors medically to maximize transplant potential, and then to surgically recover the organs and ensure they are utilized by the programs with patients waiting.

Each of those steps is highly interdependent. And, as you pointed out, the growth has been significant — over 50% increase in deceased organ donation in the US and roughly 6.7% annual growth in transplants since 2013. That’s remarkable. Yet, we still have about 180,000 patients waiting, and some die waiting. We know there’s more that can and should be done to optimize this process.

Dan

Unpacking the system and the levers of change that could lead to improvements is critical. What are some of the key changes that have occurred, or that could unlock further progress?

Alex

The donation-to-transplantation process is incredibly complex. It begins with identifying a potential donor in a hospital. Donor hospitals need to improve their ability to identify and refer potential donors in a timely fashion to organ procurement organizations (OPOs). We’ve seen substantial improvements there.

Then, OPOs respond and work to respond quickly and capitalize on every potential donation opportunity. We’ve also introduced innovative approaches to surgical recovery and organ preservation, which help us evaluate organs that might have previously been deemed unsuitable. These advances have opened new opportunities to use organs more effectively.

Kevin O’Connor

Many transplant programs in the US are working hard to increase capacity and improve their ability to utilize the increasing number of organs available. However, a major challenge remains — the underutilization of available organs. For example, over the past five years, more than 20% of recovered kidneys have not been transplanted. Last year, in 2020, over 5,000 kidneys recovered were not transplanted, which is a huge missed opportunity.

Dan

Kevin, you mentioned LTL earlier. We should clarify that LTL is the abbreviation for LifeCenter Northwest, which is a nonprofit organization designated by the federal government to serve a specific geographic area. They coordinate organ donation and transplantation from potential donor identification all the way through to transplantation. The process is a complex labyrinth, and many stakeholders work hard to make it happen. No one wants to see an opportunity missed. Looking ahead, there’s a lot of potential. What areas should we focus on?

Alex

One key area for growth is in older donors. Ensuring organs from donors over 60 are recovered and effectively utilized is crucial. The system needs to work together across its components to realize these results. It’s not just about recovering more organs from older donors but actually transplanting them to benefit patients.

We need to address barriers and incentives to improve utilization. For example, the report found that, with modest improvements, we could increase kidney transplants by about 2,000 annually — moving from roughly 28,000 to over 30,000 transplants per year by 2026.

Kevin

Currently, about 80% of recovered kidneys are transplanted, but 20% are not. Moving that to 84% would mean roughly 1,070 additional transplants annually. Small percentage increases in utilization, combined with increased recovery from older donors, could significantly impact the number of transplants.

These incremental improvements need to happen in coordination. If one component improves in isolation, the full potential isn’t realized. All parts of the system must align with success metrics, regulatory and financial incentives, and disincentives to maximize organ utilization.

Dan

What about the broader cultural and policy shifts needed?

Alex

We need to rethink metrics. For example, the current focus on one-year graft survival constrains programs’ willingness to push boundaries. Major societies are working on new metrics that emphasize longer-term outcomes, which could encourage more aggressive utilization of organs.

Also, there’s a huge opportunity to increase donation from older donors. European countries like France and the UK have higher average ages for donors — around 50 to 60 — compared to the US, where the average is around 35 to 40. We could increase the number of patients who die in a manner that makes them potential donors.

Kevin

Many patients awaiting kidneys are over 60, and outcomes from organs from older donors are often better than no transplant at all. Shifting the narrative to focus on patient-centered outcomes could help us better utilize available organs.

Additionally, transparency about organ decline reasons is limited. Improving understanding of why organs are declined could help increase utilization. For example, a study shows that patients who die waiting for a kidney receive on average 16 offers, yet many are declined, and those patients ultimately die without a transplant.

Dan

That’s a shocking datapoint. Engaging patients in discussions about organ offers and acceptance could improve outcomes. Moving toward localized recovery teams, as in the UK, could also improve efficiency and organ utilization.

Kevin

The Organ Donor Recovery Consortium is exploring establishing localized recovery teams, which have been successful in the UK. This approach could lead to better system efficiencies and higher organ utilization.

Dan

Based on these insights, what is the potential for growth in US deceased donor kidney transplants?

Alex

We could realistically see over 28,000 transplants annually by 2026 if we implement these modest but coordinated improvements. The US already has one of the best deceased organ donation systems in the world, surpassing Spain in 2020. But there’s still significant room for growth to meet the needs of all waiting patients.

Dan

It’s exciting to think about capturing this potential and making a real impact. Thank you both for your insights and efforts in this critical area.

Thanks for listening to the Oliver Wyman Health Podcast, brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.

This transcript has been edited for clarity.