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In late May, the Centers for Medicare and Medicaid Services (CMS) released the latest performance report from the country's 55 Organ Procurement Organization (OPOS), a nonprofit organization responsible for organ recovery from deceased donors.
The 2025 report shows that the significant improvement from the 2003 assessment is reduced from 24 (42%) to 10 (18%), and the number of top-performing tier 1 OPOs to 30 (54%).
However, following the 2026 report, CMS' plan to revoke the certification of the Tier 3 OPO, has increased the ongoing debate on the accuracy, fairness and impact of the report.
Report
CMS launched its OPO performance rankings in 2022 as part of a larger effort to modernize the country's port system, following criticisms that many years of criticism were unfair and inefficient.
The annual CMS assessment uses data from two years ago (for example, the 2025 assessment reflects the 2023 data). The CMS applies two metrics to measure the performance of the OPO.
Donation Rate: Percentage of Potential Donors with At least one organ transplanted: Number of Transplanted Organs as the Percentage of Potential Donors
Potential donors are defined as hospital patients under the age of 75 where death is compatible with donations. CMS compares each OPO with national data from the previous year. The top 25% are designated as Tier 1, with those below the previous year's median being placed in Tier 3, while those between them are assigned to Tier 2.
To date, CMS has never revoked its OPO contract, but this will change with a 2026 performance rating. At the end of the current four-year contract cycle next year, all Tier 3 OPOs will be exempt, allowing higher-performing OPOs to bid on the contract. Tier 2 OPOS must compete with other interest OPOs to maintain service areas.
Dispute the metric
The improvement in OPO performance in the 2025 report is “the outcome of transparency and accountability related to current outcome measures,” a CMS spokesperson told Medscape Medical News.
Jeff Trageer, executive director of LivesHaring, a consistently tier 1 OPO based in San Diego, said the new results were “clearly 'ignite fire' and Opos is trying to improve.
He noted that many Opos have invested heavily in advocacy to convert eligible deceased donors into actual donors, adjust their donation strategies to communities, and expand organ offers to remote transplant centers to reduce the number of discarded organs.
AOPO and its 47 member organizations have raised multiple challenges. The Trageser, known as the CMS Performance Assessment, warned that it was significantly flawed and could punish the OPO for steady progress.
OPOs should not be responsible for the number of implants, as hospitals decide which organs to accept or reject, Trageser said.
Sean Fitzpatrick, chief executive of New England Donor Services (Tier 2), argued in a recent statement that CMS methodology is unfairly punishing large-scale OPOs. A recent simulation study published in the American Journal of Transplantation has similar claims, suggesting that the system “systematically identifies larger OPOs as poorly performed.”
However, CMS said, “We are paying attention through a spokesman that large and small opos have moved between the performance layers. [from year to year]which demonstrates that success is driven by operational effectiveness rather than size. ”
Regional differences are concerns
David Destefano, who shares Hope SC in Charleston, South Carolina, said his OPO has increased donations and transplants by 30% since 2017 through better coordination with community partnerships and transplant centers. However, OPO remains in tier 3. He attributes this to a higher proportion of disease-free, unavailable organs, mainly in rural service areas, where there is no access to health care. CMS should risk adjust for performance metrics to reflect geographical differences in sociodemographic factors, he said.
A CMS spokesperson said, “While there are population differences across geographical areas, there are no indications that these differences affect the likelihood of donors and are at a disadvantage to one OPO compared to other OPOs.”
I'm approaching authentication
In 2026, Tier 3 Opos can sue an announcement. Their contract will remain valid until January 31, 2027, and “to allow time for appeals and prevent disruption to organ donation services,” a CMS spokesperson said.
But confusion is inevitable, Tlager said.
“Authentication leads to chaos and leads to a decrease in organs available for transplantation,” he said. It will be a valuable time to administer the logistics of taking over service areas, rather than “their central mission to work with families to advocate for donations and assign those organs during times of crisis.”
AOPO CEO Steve Miller said the departure of staff at Opos, where Opos was accused, could further erode relations with the transplant hospital.
Tier 1 Opos Eye Expansion
Matthew Wadsworth, president and CEO of Life Connection, Ohio (Tier 1), supports the CMS review process. Taking over the service area will include “a lot of work,” but he said the donation will improve quickly and rapidly under new leadership, adding that there will be no confusion.
Wadsworth is preparing to bid for at least one Tier 3 service area. He said the expansion would create economies of scale for his smaller OPOs and reduce its operating costs.
“We went through financial modeling of it and we had conversations with the bank,” he said.
However, details of the receiving process remain unknown, such as whether the receiving OPO will inherit the asset from the outgoing oppos.
The lack of clarity “puts us in a tough situation,” Wadsworth said.
The CMS said that it would only be possible to release certification guidance prior to the performance assessment next spring.
Barbara Mantel is an award-winning reporter who writes about public health and health policies.
