Introduction

Organ procurement organizations (OPOs) are entities that play an integral role in the organ transplantation process through the provision of all activities related to organ donation. This includes education of the general public, education of medical professionals in hospitals, assisting hospitals with the development of written policies and procedures, obtaining family consent, medical evaluation of potential donors, the surgical removal of organs, organ preservation, organ distribution, and follow-up with participants of the recovery process. The OPO is also responsible for required reporting to the national Organ Procurement and Transplantation Network (OPTN), the Center for Medicare and Medicaid Services (CMS) and, in some cases, state health organizations.

Initially, OPOs were formed within academic transplant hospitals, typically in the department of surgery, to support the hospital's kidney transplant program. In the late 1960s and early 1970s, a few of these entities formed their own governing structures and separated from the transplant hospitals to form independent, not-for-profit corporations. As more OPOs began operating as separate corporations, several bonded together to form a trade association, the Association of Independent Organ Procurement Agencies (AIOPA). This organization has evolved to include independent and hospital-based OPOs and is now the Association of Organ Procurement Organizations (AOPO).

Through the 1970s and midway through the 1980s, OPOs were essentially unregulated. Typically organ allocation occurred only locally and was at the direction of the transplant program(s). Organ sharing beyond the local programs was driven by expediency and, to some extent, medical priority. Early efforts to allocate organs via a structured system were coordinated through various organizations including individual OPOs, the Southeastern Organ Procurement Foundation (SEOPF) and the North American Transplant Coordinators Organization (NATCO). Authorized by the National Organ Transplant Act of 1984, the United Network for Organ Sharing (UNOS) currently holds a federal contract to be the OPTN. In recent years, UNOS has established and now oversees the national organ sharing system. All OPOs are required to be members of the OPTN.

During the development of the National Organ Transplant Act and shortly after its passage, there was a substantial shift from hospital-based OPOs to independent OPOs. Another remarkable effect of the legislation was a striking reduction in the number of OPOs. Currently, OPOs are regulated in terms of governance, function and performance. As reporting requirements have increased, so have

Organ Transplantation, 2nd edition, edited by Frank P. Stuart, Michael M. Abecassis and Dixon B. Kaufman. ©2003 Landes Bioscience.

performance expectations. Most OPOs now expend significant resources promoting organ donation initiatives through public, professional and legislative avenues.

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