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Signals Brief: CMS Just Announced The Increasing Organ Transplant Access (IOTA) Model
Here's what you need to know about the new model, where you can learn more, and how to share your feedback
Friends and fellow explorers,
Today, the Centers for Medicare & Medicaid Services (CMS) announced a new proposed model that aims to increase access, equity, and outcomes in kidney transplantation. The Increasing Organ Transplant Access (IOTA) Model marks an important moment for the transplant community, and complements existing (and future) regulatory efforts for Organ Procurement Organizations, nephrologists, and dialysis facilities to improve the overall transplant system for people with ESRD.
This post summarizes key points and brings relevant resources into one place. Over the next several weeks, we will go through the proposed rule in more detail, collect feedback and share reactions from the community. For now, let’s focus on what we know— and what this means for the future.
Have tips or feedback? Hit reply or join the conversation here.
Reading time: 7 minutes
Background
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is announcing the Increasing Organ Transplant Access (IOTA) Model. The proposed model aims to increase access to kidney transplants for all people living with end-stage renal disease (ESRD), improve the quality of care for people seeking kidney transplants, reduce disparities among individuals undergoing the process to receive a kidney transplant, and increase the efficiency and capability of transplant hospitals selected to participate.
This proposed model would build on the Biden-Harris Administration’s priority of improving the kidney transplant system and the collaborative efforts between CMS and the Health Resources and Services Administration (HRSA) to increase organ donation and improve clinical outcomes, system improvement, quality measurement, transparency, and regulatory oversight. HRSA is taking transformational steps to modernize the critical organ matching technology while increasing transparency and accountability by issuing new data reporting requirements to better address pre-waitlist and organ procurement practices, which will help address inequities in the transplant waitlist process by reducing racial and ethnic variation both in patient referrals and in organ procurement.
The IOTA model also aligns with the HHS Organ Transplant Affinity Group’s initiatives to increase transplantation access through payment, quality, and regulatory efforts.
Model Aims
The model would be implemented by the CMS Innovation Center and run for six years, beginning January 1, 2025, with the aim to:
Increase access to kidney transplants for people living with end-stage renal disease.
Improve the quality of care for people seeking kidney transplants.
Reduce disparities in kidney transplantation.
Increase the efficiency and capability of transplant hospitals selected to participate.
Transplant hospitals assigned to participate in the model would be assessed on how well they increase the number of transplants, improve equity in the transplant process, increase organ acceptance rates, and improve post-transplant outcomes.
“Kidney transplantation helps people live healthier and longer lives because they no longer have to undergo dialysis. The Increasing Organ Transplant Access Model would be an important step forward in improving the kidney transplant process for everyone on a waitlist and those who have received a transplant.”
An Unmet (and Growing) Need
Kidney transplantation is the best treatment for most individuals with ESRD, a condition that occurs when the kidneys are no longer able to function properly. People with ESRD who receive transplants have better outcomes than people who receive dialysis, improvements in quality of life, and are freed from lengthy and burdensome dialysis treatments.
However, the scarcity of organs, particularly for kidney transplants, leads to increased patient mortality and a significant gap between demand and supply. Despite this scarcity, approximately 30% of donor kidneys go unused annually, highlighting gaps in procurement, distribution, and utilization. Prolonged waiting times, averaging three to five years or more, intensify patient suffering. With just over 28,000 kidney transplants performed in 2023 and more than 90,000 people on a waitlist during that same time, urgent measures are needed to improve the efficacy and efficiency of the system.1
Resources & Data
Quick Links
Reports
The Transplant Eco-System: The Role of Data in CMS Oversight of The Organ Procurement Organizations. In this blog, CMS outlines its strategy for OPOs. OPOs are non-profit organizations responsible for the procurement, distribution, and transplantation of human organs in a safe and equitable manner for all potential transplant recipients. They serve an essential role in supporting donor families, clinical management of organ donors, and professional and public education about organ donation. OPOs identify potential organ donors, request consent from the families of donors in the absence of a donor document, procure organs, work with other agencies to identify potential transplant recipients and ensure that organs are transferred to transplant hospitals.
The Costly Effects of an Outdated Organ Donation System. This research report details how and why more than 28,000 viable organs are wasted each year. Despite scientific advancements, the organ donation system is held back by poor management and performance. The U.S. government could save tens of thousands of lives and billions of dollars by holding contractors to more rigorous standards and modernizing the technology within the organ transplant ecosystem.
Data
Organ Donation Statistics. How many people are waiting for a transplant? Who receives organs, and what organs are most needed? Explore data from the Organ Procurement and Transplantation Network.
Organ Procurement and Transplantation Network (OPTN). The Organ Procurement and Transplantation Network (OPTN) is a unique public-private partnership that links all professionals involved in the U.S. donation and transplantation system. OPTN data allows us to explore current and historic (since 1988) U.S. donation and transplant trends at national and regional levels.
OPO Data. The data on this page were collected from the Organ Procurement and Transplantation Network (OPTN) and Centers for Medicaid and Medicare & Medicaid Services (CMS).
Discussion
What’s your take on this new proposed model? How do you think the model would improve access, equity, and outcomes in the short and long run? What have we learned from past ESRD models that will be useful or should keep in mind with IOTA? Who should we hear from on this topic as we gather our thoughts over the next few weeks?
Leave a comment below or join the kidney chat and let us know what’s on your mind.
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https://www.organdonor.gov/learn/organ-donation-statistics