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The little heart icon on a driver's license that says you're an organ donor and the heartwarming stories of lives saved can mask the true complexity of America's organ transplant system, which relies on organ procurement organizations to get lifesaving organs from donor to patient. 

The federal government is taking a closer look at the organizations, called OPOs. It says Minnesota’s OPO, LifeSource, among others, are underperforming.

Rochester Post Bulletin reports

 It may be costing lives

Under federal investigation

Nora Eckert is a reporter for the Rochester Post Bulletin and has been working on an investigation into LifeSource. She joined All Things Considered host Tom Crann Monday to share her reporting.

The following is a transcript of the conversation, lightly edited for clarity. Listen to the full conversation with the audio player above.

LifeSource in Minnesota is underperforming. What’s happening and why?

OPOs play the critical role of when someone dies in a hospital, sending their team there, talking with the family of the deceased person, and trying to get them to consent to donation. They also have to transport organs that are retrieved from the donor to a transplant center. So OPOs are being measured on their donation rate, and also on transplantation rate. 

From their first [Centers for Medicare and Medicaid Services] report card, LifeSource was at the bottom of the underperforming [ratings tier]. They needed 12 donors more to be classified as a well-performing OPO. Now they've met that bar, and they need zero more donors to be classified as a good-performing OPO. 

But we need to also look at that organs-transplanted metric. They once needed 71 additional organs to be considered a tier-one [OPO]. Now they need 20 more. 

What spurred this regulatory push was a series of reports, some from the government, some from outside entities, that showed that OPOs are missing upwards of 30,000 potential donors annually. So when you think about a waitlist of 100,000 people — a list that 31 people die waiting on every single day — if you start cutting down on 30,000 more donors every year, you're saving so many lives.

LifeSource is saying that they plan to double the number of donations by the year 2027. What is their plan?

What’s essential to improving OPO performance is staffing. If you don't have folks to get to the hospital to identify potential donors and to ensure that their organs are viable for transplant, you fail as an OPO. And LifeSource has a challenge in that their service area is really large. It's the second-largest of any OPO in the nation. 

LifeSource covers Minnesota, the Dakotas and a sliver of Wisconsin, and they are the only OPO for that service area. So they need, really, an army of folks to meet potential donors. And that's something that Susan Gunderson, who is their CEO and is retiring next year, said she's committed to doing.

In all of your reporting on this issue, what do you think is the most important takeaway?

The thing that shocked me is the sort of coordinated campaign from many OPOs to prevent the implementation of a more transparent, objective system. I understand that this is an extremely nuanced area. It's very complicated.

But in some ways, it's quite simple: OPOs were charged with following a more objective rule that the government proved would save more lives, and they fought back, oftentimes using lobbyists and false information. And now that the rule has been approved, there's been a massive increase in OPO performance, including LifeSources performance, and that translates into more lives saved. So I found myself asking from the start, why is there such a resistance to transparency if the ultimate goal is saving lives?

Listen to the full conversation with the audio player above.

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The federal government is taking a deeper look at organ procurement organizations, after a series of reports found they were missing tens of thousands of potential organ donors a year. Every day, an estimated 31 people die waiting for an organ transplant.

Nora Eckert talks about her LifeSource investigation with Rochester Post Bulletin

A view outside a building, a sign reads "LifeSource"

Reporter Nora Eckert describes Minnesota's underperforming organ transplant system

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