Increases in Organ Donation in Donor Hospitals Changing Organ Procurement Organization Affiliations.

INTRODUCTION: Hospitals in the United States are assigned to a designated organ procurement organization (OPO) responsible for managing deceased donors in the designated donation service area (DSA). Hospitals can apply for waivers to work with a different OPO with appropriate justification. We sought to evaluate the impact of hospital waivers on organ donation activity. METHODS: We evaluated Organ Procurement and Transplantation Network (OPTN) data from two OPOs (Donor Network West and Honor Bridge), each with a hospital (Renown Regional Medical Center and North Carolina Baptist Hospital) in its DSA granted a waiver to work with a different OPO beginning in April 2025. We assessed changes in the number of organ donors and organs transplanted pre- and post-granting of a waiver using a difference-in-differences approach based on multilevel mixed-effects models. RESULTS: After switching OPO affiliations, mean monthly donors at intervention hospitals increased from 5.6 pre-waiver to 7.9 post-waiver, while control hospitals remained stable (56.6 vs. 57.5 donors/month). Mean monthly organs transplanted increased from 16.5 to 24.9 at intervention hospitals, while control hospitals were unchanged (170.9 vs. 169.3 organs/month). The difference-in-differences interaction term was statistically significant for both donors recovered (p < 0.1) and organs transplanted (p < 0.1). Reported deaths were stable in both groups. CONCLUSION: With eight months of post-waiver data, hospitals with granted waivers had significant increases in donation activity driven by improved donor conversion rather than changes in referral patterns or organ yield per donor. Although longer-term data are needed to confirm these findings, CMS and the organ transplant community should feel confident that changing donor hospital-OPO affiliations will not negatively impact donation and may lead to significant increases in donation.