An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will conduct a study to examine the economic (costs), ethical, policy, regulatory, and operational issues relevant to organ allocation policy decisions involving deceased donor organs (e.g., heart, lung, liver, kidney, kidney-pancreas, intestinal, vascular composite allografts, dual and/or multi-organ organ transplants). The committee will examine the gaps, barriers, and opportunities for improving deceased donor organ procurement, allocation, and organ distribution to waiting recipients at transplant centers with a keen eye towards optimizing the quality and quantity of donated organs available for transplantation – in a cost effective and efficient, fair and equitable manner consistent with the National Organ Transplant Act and the Final Rule.
Specifically, the final report will delineate the issues pertinent to organ allocation policy, modelling and simulation of anticipated policy changes for intended and unintended consequences, and the process for efficiently executing allocation policy changes in an open, transparent, fair, and equitable manner. The report will make recommendations to maximize public and professional trust in the organ donation, procurement, allocation, and distribution process. The report will also make recommendations to better align the performance metrics or incentives of various stakeholders within the Organ Procurement and Transplantation Network [specifically donor service areas (DSAs), organ procurement organizations (OPOs), and transplant centers] to maximize donor referrals, evaluations, procurement and organ placement/allocation while minimizing organ discard rates.
The committee will consider the following in its discussions and deliberations to address the statement of task:

• If deceased donor organs should be allocated to specific individuals based on need (i.e., national, continuous framework) rather than groups of individuals defined by locale, zip code, or donor service area (i.e., the donor service area, geographic framework) and if measures can be taken to reduce inequities in organ allocation affecting socioeconomically disadvantaged populations;
• Relevant factors that determine transplant recipient waitlist priority (i.e., “need”) for an organ;
• Best model/method(s) to ensure fairness, equity, cost effectiveness and efficiency, and reduce the reported socioeconomic and racial/ethnic disparities in the current organ allocation system;
• Challenges with current organ allocation policy development and policy change procedures and processes, including opportunities to update OPTN policies and processes to ensure organ allocation decisions consider the viewpoints of expert OPTN committees;
• Challenges involved in modeling proposed organ allocation policy changes and opportunities to improve modeling, including how costs should be factored into the modeling of organ allocation policy changes;
• Appropriate parameters, factors, and variables that should make up various transplant scoring systems (e.g., CPRA, EPTS, KDPI, LAS, MELD, etc.) that determine organ allocation and patient prioritization to assure fair and equitable practices and reduce inequalities affecting socioeconomically disadvantaged patient populations;
• How to more effectively acquire needed data points to enhance transplant scoring systems (e.g., through better sharing of donor and recipient data between various federal agency databases);
• Self-reported donation metrics (e.g., “eligible deaths”) and the impact on estimates of the true donor supply. Consider the development of a new, standardized, objective, and verifiable donation metric to permit the transplant community to evaluate DSAs and OPOs and establish best practices;
• Data sharing and optimization opportunities, revealed by the COVID-19 pandemic, via collaboration across Department of Health and Human Services administrative databases regarding vital statistics on transplant recipients and potential donors to better inform policy makers, the OPTN, OPOs, transplant centers, transplant healthcare workers, patients, and the public; and
• Relevant comparisons to international allocation policies and models.