AILSA CHANG, HOST:
On its way out, the Trump administration is increasing oversight of the nonprofits that do the hard work of finding organs to transplant. The policy change is meant to boost the overall number of transplants performed in the U.S. so fewer people die waiting, but it is also exposing the geographic discrepancies in organ procurement. Blake Farmer of member station WPLN in Nashville reports.
BLAKE FARMER, BYLINE: Organ transplants are not as simple as someone dies and someone like John Caso gets a new heart.
JOHN CASO: Well, you never expect to get the call that says, we have an organ, but...
FARMER: It was 2004, and Caso had just been listed to get a new heart. But this one was from someone who had traded sex for drugs. Doctors couldn't guarantee there wouldn't be infections.
CASO: I followed the advice of the surgeon, who said, let's turn it down.
FARMER: Caso could afford to be a little more choosy. He lives in the Appalachian Mountains of northeast Tennessee, and the region's poor health outcomes - like higher rates of strokes, fatal car crashes and gunshot deaths - actually benefit organ recipients. In other parts of the country, particularly the East and West coasts, people don't die as often from those causes that make for good organ donation candidates. That discrepancy is what some organ procurement organizations have pointed to to explain why they collect fewer organs compared to other regions. Organ procurement organizations, or OPOs, have always self-reported their data, but under the new rules, that ends.
SETH KARP: This is about understanding why certain areas are not performing well and seeing if we can fix them.
FARMER: Dr. Seth Karp directs the transplant program at Vanderbilt University Medical Center in Nashville. He says new federal rules hold these nonprofits accountable for all the potential donors they missed. By the new accounting, Las Vegas yields roughly four times as many organ donations as New York City.
KARP: If it is true that certain parts of the country should only be able to recover one-fourth of the number of donors as another part of the country because there are inherent differences in those areas of the country, that's fine. You know, we can live with that. I just find that hard to believe.
FARMER: And yet some organ procurement officials say the new rules miss a big problem over which they have little control - finding people to take the available organs. This month the OPO that stretches from Connecticut to Maine had a 59-year-old in a fatal bicycle accident. CEO Alexandra Glazier says the family signed off, and the OPO considered the kidneys in good shape.
ALEXANDRA GLAZIER: We made thousands of organ offers and ultimately weren't able to place those kidneys for transplant despite almost 33,000 offers.
FARMER: Once organs are turned down a few times, other surgeons assume there must be something wrong with them. That's why Glazier questions the new rules meant to increase transplants. They focus on organ procurement but don't subject surgeons and transplant centers to more scrutiny.
GLAZIER: We know that there is opportunity to do a lot better systemwide, but what this requires is the full engagement of the system.
FARMER: Glazier also objects to another new policy. If low-performing OPOs don't improve, they would eventually be taken over by high performers. Glazier calls it a "Hunger Games" scenario that, in her view, could lead to even fewer organ transplants. It's easy to point fingers, says Dr. Matthew Cooper. He directs kidney transplantation at MedStar Georgetown in Washington, D.C.
MATTHEW COOPER: Perhaps it's not as simple as you think it is. It's not as simple for me, as a transplant program, to go to a donor family and say, listen; you know, why don't you donate your organs? I would probably be really bad at that.
FARMER: And Cooper worries that a punitive approach won't benefit any of the nonprofits doing the work.
COOPER: I fear that we are going to have more chaos than we're going to have value.
FARMER: What everyone agrees on is that there are big differences in organ availability between states. A change in how to track that may confirm some regions just have it harder or show that a few organ donation nonprofits need to step it up.
For NPR News, I'm Blake Farmer in Nashville.
CHANG: And this story was produced in partnership with Nashville Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.