HMS Study Finds Organ Donation Process Faulty

Staggering inefficiencies in the donation process mean that thousands of viable organs go unused, a Harvard Medical School (HMS)-led study has found.

Edward Guadagnoli, associate professor of health care policy at HMS, along with researchers from Boston University and the non-profit Institute for Healthcare Improvement, published their findings in last week’s issue of Health Care Financing Review.

The team suggested that efforts by organ procurement organizations (OPO) to limit inefficiencies could potentially double the number of organs available for donation and help to alleviate the long-standing chronic organ shortage.

“The most important benefit of the study is that we now have a sense of how efficient OPOs are in terms of converting potential donors to organ donors—only approximately 35 percent efficient on average,” Guadagnoli said.

With a waiting list more than 80,000 names long, and only 6,200 donations last year, improving procurement efficiency can help to alleviate the nationwide organ shortage, but it will not match growing organ demand, according to a statement released Friday by HMS.


This low rate of conversion is partially attributable to the difficulty OPOs face in asking for family consent at a particularly sensitive time—directly following the brain death of the potential donor.

According to Guadagnoli, the government has set 75 percent efficiency as a target, a level which the study estimated would increase the number of donors to 12,598.

He said he hopes that his study will “stimulate discussion” not only about “what level of efficiency is acceptable for OPOs,” but also “regarding how best to use available resources and new technologies related to organ donation.”

Despite the growing possibility of xenotransplantation—using animal organs for transplants—and organ engineering, Guadagnoli said he doesn’t “think there is anything on the horizon that will quickly fill the gap” between organs donated and the number of patients waiting for donation.

In terms of policy changes, Guadagnoli suggests that the United States, where “family consent is usually always required even if the deceased has signed a donor card,” could learn from Spain, where “organ donation is assumed.”

He also suggested that separating the discussion of brain death from the organ donation, requesting family permission “in a private quiet place,” and ensuring that “an OPO staff member and a staff member of the hospital” make the request could make families more comfortable giving permission for the donation.

Whatever the solution, Guadagnoli said steps must be taken quickly to alleviate the “chronic shortage of organs,” especially as “the disparity between those who need organs and the available supply has increased steadily over time.”