Organ Donation : Supply, Policies and Practices.

Intro -- ORGAN DONATION: SUPPLY, POLICIES AND PRACTICES -- ORGAN DONATION: SUPPLY, POLICIES AND PRACTICES -- CONTENTS -- PREFACE -- Chapter 1 ORGAN DONATION: UTILIZING PUBLIC POLICY AND TECHNOLOGY TO STRENGTHEN ORGAN DONOR PROGRAMS* -- BACKGROUND -- CURRENT ACTIVITIES -- FUTURE ACTIVITIES -- Breakthrough Collaboratives -- Scientific Registry of Transplant Recipients (SRTR) -- Organ Donation Support -- Public and Professional Education Programs -- CONCLUSION -- Chapter 2 INFORMATION POLICY, CENSUS, AND NATIONAL ARCHIVES SUBCOMMITTEE, OVERSIGHT AND GOVERNMENT REFORM COMMITTEE, "ORGAN DONATION: UTILIZING PUBLIC POLICY AND TECHNOLOGY TO STRENGHTHEN ORGAN DONOR PROGRAMS"∗ -- WHAT IS THE NATIONAL MOTTEP MODEL? -- A 25 YEAR DATA ANALYSIS OF A NATIONAL DONOR EDUCATION PROGRAM -- CADAVERIC DONORS PER 1,000 EVALUABLE DEATHS AND NUMBER OF DONORS BY ETHNICITY AND OPO'S, 1995-1998 -- NATIONAL MOTTEP'S PAST ACCOMPLISHMENTS -- MOTTEP MILESTONES -- I.A. 1991 - 1993 -- I.B. 1993 -1995 -- II. 1995 to 1999 -- Other "Firsts" Accomplishments Include (1993-1995): -- MOTTEP OF HONOLULU - ACCOMPLISHMENTS -- SUMMARY -- Methodolgy -- Results -- CADAVERIC DONORS PER 1,000 EVALUABLE DEATHS AND NUMBER OF DONORS BY ETHNICITY AND OPO'S, 1995-1998 -- CONCLUSION -- Chapter 3 TESTIMONY BEFORE THE UNITED STATES HOUSE OF REPRESENTATIVES, INFORMATION POLICY, CENSUS AND NATIONAL ARCHIVES SUBCOMMITTEE, OVERSIGHT AND GOVERNMENT REFORM COMMITTEE, "ORGAN DONATION: UTILIZING PUBLIC POLICY AND TECHNOLOGY TO STRENGTHEN ORGAN DONOR PROGRAMS"* -- THE BOTTOM LINE - SUPPLY DOES NOT MEET DEMAND -- EDUCATION AND AWARENESS - PATIENTS &amp -- PHYSICIANS -- OUTREACH TO UNDERSERVED PATIENT POPULATIONS -- ADDRESSING DISPARITIES IN SOLID ORGAN TRANSPLANTATION -- REMOVING FINANCIAL DISINCENTIVES - FAMILY AND MEDICAL LEAVE POLICIES.

Chapter 4 STATEMENT BY SUSAN DUNN, ASSOCIATION OF ORGAN PROCUREMENT ORGANIZATIONS, DONOR ALLIANCE, INC., BEFORE THE INFORMATION POLICY, CENSUS, AND NATIONAL SUBCOMMITTEE ARCHIVES, OVERSIGHT AND GOVERNMENT REFORM COMMITTEE, SEPTEMBER 25, 2007∗ -- INTRODUCTION -- THE CRISIS -- EXTRAORDINARY RESULTS AND IMPROVEMENTS -- A National Experiment -- ORGANS RECOVERED AND TRANSPLANTED FOR EACH DONOR IS ALSO CRITICAL -- THE 2006 REVISED UNIFORM ANATOMICAL GIFT ACT (UAGA) -- DONORNET 2007 -- ORGAN DONATION AND RECOVERY IMPROVEMENT ACT -- CONCLUSION -- Chapter 5 TESTIMONY OF ELIZABETH M.P. RUBIN, BEFORE THE INFORMATION POLICY, CENSUS AND NATIONAL ARCHIVES SUBCOMMITTEE OF THE HOUSE OF REPRESENTATIVES ON OVERSIGHT AND GOVERNMENT REFORM COMMITTEE, SEPTEMBER 25, 2007∗ -- Chapter 6 INFORMATION POLICY, CENSUS, AND NATIONAL ARCHIVES SUBCOMMITTEE OVERSIGHT AND GOVERNMENT REFORM COMMITTEE, "UTILIZING PUBLIC POLICY AND TECHNOLOGY TO STRENGTHEN ORGAN DONOR PROGRAMS,"∗ -- Chapter 7 OPENING STATEMENT OF EVERSON WALLS, INFORMATION POLICY, CENSUS, AND NATIONAL ARCHIVES SUBCOMMITTEE, OVERSIGHT AND GOVERNMENT REFORM COMMITTEE ∗ -- Chapter 8 LIVING ORGAN DONATION AND VALUABLE CONSIDERATION* -- ABSTRACT -- INTRODUCTION -- Demand for Transplantable Organs -- United States Organ Procurement System -- Living Donation -- Directed Living Donation and Valuable Consideration: Paired Donation and Other Types of Exchanges -- IMPACT OF LIVING DONATION ARRANGEMENTS ON ORGAN SUPPLY -- LEGAL ISSUES RELATING TO VALUABLE CONSIDERATION AND LIVING DONATION ARRANGEMENTS -- Statutory Prohibition in NOTA -- Valuable Consideration and Living Donation Arrangements -- ETHICAL AND POLICY ISSUES RELATED LIVING ORGAN DONATION, AND PAIRED AND LIST DONATION -- Evolving Transplantation Systems -- Ethical Issues Related to Living Donation -- Above All, Do No Harm -- Risk-Benefit Ratios.

Informed Consent -- Ethical Issues Related to List Donation: Blood Type O -- Ethical Issues Related to Directed Donation (Paired and List) -- Allocation -- Parity -- Ethical Issues Related to Proposals for Expanding the Organ Supply: Exchanging Valuable Consideration for an Organ -- REFERENCES -- Chapter 9 ORGAN TRANSPLANT PROGRAMS: FEDERAL AGENCIES HAVE ACTED TO IMPROVE OVERSIGHT, BUT IMPLEMENTATION ISSUES REMAIN* -- WHAT GAO FOUND -- WHY GAO DID THIS STUDY -- WHAT GAO RECOMMENDS -- ABBREVIATIONS -- RESULTS IN BRIEF -- BACKGROUND -- Organ Transplantation Process -- The OPTN's Role and Responsibilities -- HRSA's Oversight of the OPTN -- CMS's Role and Responsibilities -- LIMITATIONS EXISTED IN FEDERAL OVERSIGHT AT THE TIME HIGH-PROFILE PROBLEMS CAME TO LIGHT -- CMS's Oversight Was Limited and Inconsistent -- CMS Did Not Actively Monitor Extra-Renal Transplant Programs -- CMS Had a Process in Place to Monitor Renal Transplant Programs, but Some Programs Still Were Not Actively Reviewed -- The OPTN's Oversight Was Active and Multipronged but Was Not Sufficient to Detect All Problems -- The OPTN Actively Monitored for Many Types of Problems -- The OPTN's Monitoring Did Not Detect All High-Profile Cases and Was Not Always Timely -- CMS, HRSA, AND THE OPTN HAVE ACTED TO STRENGTHEN OVERSIGHT, BUT THE FULL EFFECT OF THESE ACTIONS WILL DEPEND ON IMPLEMENTATION AND FURTHER INFORMATION SHARING -- CMS Strengthened Oversight by Expanding Monitoring Efforts and Issuing New Regulations -- CMS Began Monitoring Extra- Renal Transplant Programs and Took Steps to Withdraw Medicare Approval from the Most Problematic Programs -- CMS Established New Requirements that Apply to All Types of Transplant Programs -- New Regulations Also Established Procedures for Reviewing Transplant Programs.

The OPTN and HRSA Have Taken Steps to Address Shortcomings in Detection of Problems -- CMS, HRSA, and the OPTN Have Yet to Fully Implement Several Measures to Improve Oversight -- CMS, HRSA, and the OPTN Are Sharing Basic Data on Transplant Programs, but How They Will Share Additional Information from Their Oversight Activities Has Not Been Resolved -- CONCLUSIONS -- RECOMMENDATIONS FOR EXECUTIVE ACTION -- AGENCY COMMENTS -- APPENDIX I: MEDICARE CONDITIONS OF PARTICIPATION FOR TRANSPLANT CENTERS -- APPENDIX II: COMMENTS FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES -- REFERENCES -- INDEX -- Blank Page.

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