The Turf War explodes over organ donation services

By Michelle Crouch

Charlotte ledger

The lawsuit filed earlier this month aims to stop Atrium Health from managing organ donation services at Wake Forest Baptist Medical Center in Winston-Salem.

For 40 years, Wake Forest Baptist relied on Honorbridge, an independent organ procurement organization that serves 75% of North Carolina, processing hospital life-saving organ donations and rely on transplant recipients.

However, after joining the Atrium Health System, Wake Forest Baptist petitioned the federal government to switch to Lifeshare Carolina, the Atrium's internal organ procurement service.

Citing Lifeshare's higher donations and increased transplant rates, Atrium said the change will lead to increased efficiency, increased organ donation and reduced costs.

Federal regulators approved Atrium's request in December, and Lifeshare planned to take over in April.

However, on March 11, Onau Bridge sued to stop change, claiming that federal regulators had stepped over their powers. Honorbridge said the decision would end the 40-year relationship without reason, disrupt the recovery and transplant of local organs, and put lives at risk.

He also said the change would cause “irreparable damage” to Honorbridge and hospitals, including UNC Health and Duke Health, by reducing tissue from the largest provider of organs.

“We've been embedded in the community for 40 years here and have established collaborative practices based on trust,” said Chuck Heald, director of advocacy and marketing at Honorbridge. “Now, Atrium Cherry-Pick, at this high-performance hospital, you can receive many refunds from the number of organs you can recover and transplant.”

The organ procurement group is a non-profit organization, but it generates revenue by collecting fees for each organ that it collects. On average, it costs around $31,659 for the liver and $36,000 for the kidneys.

Atrium Health did not respond to multiple requests for comment on the lawsuit from Charlotte Ledger/NC Health News.

The legal battle highlights the problems with the country's organ transplant system and the flaws in the federal government's plan to revamp it, says Rene Landers, a law professor at Suffolk University in Boston, worked for a scientific, engineering and medicine panel commissioned by Congress to investigate the issues with the organizational contribution system.

Landers said the most controversial aspect of government reform efforts is a new ranking system for organ procurement organizations with plans to eliminate the least performers by 2026.

A hearing on Honorbridge's request for an interim injunction is scheduled for March 28th at 2pm in Wilmington.

Recent changes in organ transplant systems

More than 104,000 Americans participate in organs (mostly waiting lists for kidneys), including around 4,000 people from North Carolina.

The organ procurement organization known as OPOS plays an important role in moving people out of their waitlists. Once a hospital patient dies and is identified as a potential donor, the organization communicates with the family of the potential donor, coordinates with the medical team, matches organs with the recipient, and oversees organ movement.

In the current system, each of the country's 56 organ procurement organizations has designated service areas operating without competition.

However, in 2021, amid rising criticism of the system's inefficiency, inequality and many unused organs, the federal government gave hospitals the option to request an exemption to switch to another organization. He said the switch could be allowed as long as changes increase organ donation rates, ensure fair treatment of patients, and improve cost-effectiveness and quality.

Landers said they only know one of Nevada's well-known health hospitals that are asking them to work with another organ collection group.

The request also led to lawsuits. One procurement group accused neighboring groups of trying to elbow hospital relations by providing a $6 million kickback. This is another example of intense competition between organizations.

Wake Forest Baptist: Lifeshare performance is improving

When requesting a switch to Lifeshare, Wake Forest Baptist said the change would lead to cost and operational efficiency as it is now part of the Atrium system.

The Atrium also said it could better provide the support, resources and additional donors needed for Wake Forest Baptist research initiative.

However, the majority of hospital cases were that Lifeshare's transplant rate was 42% better than Honorbridge's, while the donation rate was 26% better. These statistics place Lifeshare at the top of the government's three-tier rating system while Honorbridge is at the bottom.

The top tier of Lifeshare is evidence that Switch “additional organ donors, organs have been transplanted and lives have been saved.” “This move will support (the government) legislative efforts to reward higher performance OPOs and increase the number of lives saved through organ donation.”

When granting the exemption request, the federal Department of Health and Human Services also cited Lifeshare's Higher Tier.

Honorbridge: The federal ranking system is flawed

Heald said he believes the decision to change the Wake Forest Baptist group came from hospital administrators rather than medical staff.

“When the exemption was first requested, hospital staff didn't even know that the hospital did it,” he said. “We had to tell them, and they weren't happy about it.”

In that lawsuit, Honorbridge said the government should not use the federal ranking system to justify the changes as the rankings are “tentative” based on the post-pandemic year and are not intended to be used to grant exemptions.

Honorbridge also argues that the rankings are even more flawed as they cannot explain demographic differences across the service areas of each organization, Heald explained.

The Atrium serves the Charlotte Metro area and western North Carolina, but he spreads across the rest of the state in Onau Bridge territory.

Hospitals may reject the perfect organ

Another problem with the new ranking is that half of the tissue scores are based on the percentage of organs successfully transplanted to the recipient. But Heald says Honorbridge has little control over its choice to accept the number of organ hospitals.

Hospitals are evaluated based on survival rates after transplant, land and law professors, so even if these organs save the patient's life, they are encouraged to reject “medically complex” organs.

“Many organs have been rejected for patients on the waiting list because doctors are waiting for organs that will get better or keep statistics high,” Landers said.

A large study published in Jama Network Open shows that on average, people who die on the waitlist due to their kidneys are donated 16 organs. In most cases, these patients do not recognize that their organs are available, Landers said.

The 2022 National Academy Report recommended changes to improve the system, including revising the way the federal government evaluates transplant centers to promote greater use of organs.

They also suggested that organ procurement organization rankings exceed transplant and donation rates, taking into account factors such as local demographics and the medical complexity of potential organs.

Concerns about the new rules

Under current regulations, organ procurement tissues compete with each other rather than being measured against fixed performance indicators, Landers said. This discourages them from sharing best practices and increases the likelihood of litigation such as Honorbridge is involved.

Because the system ranks groups with each other, some people always end up in the lower tier, regardless of their actual performance. Under the rules, the lowest-ranked organizations in 2026 will lose their contract with the federal government.

The Organ Procurement Association, the trade group representing the OPO, warns that this will result in 42% of its members losing accreditation.

Landers shares these concerns, saying that the massive announcement could leave the country without a major organ procurement organization.

She said she hopes federal health officials will rethink their policies before 2026 and consider National Academies Report's recommendations.

“As our report said, this system isn't perfect, but it's actually one of the best or second performances in the world in any year,” she said. “There's a real risk of breaking down what's working here.”

This article was updated to revise the number of patients on the North Carolina waitlist to approximately 4,000.

This article is part of the partnership between Charlotte Ledger and North Carolina Health News, and produces the original healthcare report.

This effort can be supported by tax-free donations.