{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:41:02Z","timestamp":1792291262731,"version":"4.4.0"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hospitals in the United States are assigned to a designated organ procurement organization (OPO) responsible for managing deceased donors in the designated donation service area (DSA). Hospitals can apply for waivers to work with a different OPO with appropriate justification. We sought to evaluate the impact of hospital waivers on organ donation activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated Organ Procurement and Transplantation Network (OPTN) data from two OPOs (Donor Network West and Honor Bridge), each with a hospital (Renown Regional Medical Center and North Carolina Baptist Hospital) in its DSA granted a waiver to work with a different OPO beginning in April 2025. We assessed changes in the number of organ donors and organs transplanted pre\u2010 and post\u2010granting of a waiver using a difference\u2010in\u2010differences approach based on multilevel mixed\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After switching OPO affiliations, mean monthly donors at intervention hospitals increased from 5.6 pre\u2010waiver to 7.9 post\u2010waiver, while control hospitals remained stable (56.6\u00a0vs. 57.5 donors\/month). Mean monthly organs transplanted increased from 16.5 to 24.9 at intervention hospitals, while control hospitals were unchanged (170.9\u00a0vs. 169.3 organs\/month). The difference\u2010in\u2010differences interaction term was statistically significant for both donors recovered (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.1) and organs transplanted (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.1). Reported deaths were stable in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With eight months of post\u2010waiver data, hospitals with granted waivers had significant increases in donation activity driven by improved donor conversion rather than changes in referral patterns or organ yield per donor. Although longer\u2010term data are needed to confirm these findings, CMS and the organ transplant community should feel confident that changing donor hospital\u2010OPO affiliations will not negatively impact donation and may lead to significant increases in donation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70642","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:11:27Z","timestamp":1786979487000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Increases in Organ Donation in Donor Hospitals Changing Organ Procurement Organization Affiliations"],"prefix":"10.1111","volume":"40","author":[{"given":"Isabella","family":"Sharifi","sequence":"first","affiliation":[{"name":"University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Tewksbury","sequence":"additional","affiliation":[{"name":"Life Connection of Ohio  Toledo Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Wadsworth","sequence":"additional","affiliation":[{"name":"Life Connection of Ohio  Toledo Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Division of Digestive Health and Liver Diseases University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Center for Medicare and Medicaid Services.Organ Procurement Organization (OPO) Conditions for Coverage Final Rule: Revisions to Outcome Measures for OPOs CMS\u20103380\u2010F."},{"key":"e_1_2_11_3_1","unstructured":"Hospital Waiver Request to Work with an OPO other than its Designated OPO Accessed2025 chrome\u2010extension:\/\/efaidnbmnnnibpcajpcglclefindmkaj\/https:\/\/www.cms.gov\/files\/document\/instructions\u2010hospital\u2010submit\u2010waiver\u2010request\u2010work\u2010opo\u2010other\u2010its\u2010designated\u2010opo.pdf."},{"key":"e_1_2_11_4_1","unstructured":"66 Medicare and Medicaid Programs;Announcement of Applications From Hospitals Requesting Waivers for Organ Procurement Service Areas (Office of the Federal Register)40567(2001)."},{"key":"e_1_2_11_5_1","unstructured":"Medicare and Medicaid Programs;Announcement of an Application From a Hospital Requesting Waiver for Organ Procurement Service Area (Office of the Federal Register)(2008)."},{"key":"e_1_2_11_6_1","unstructured":"Medicare and Medicaid Programs;Announcement of Application From Hospital Requesting Waiver for Organ Procurement Service Area (Pioneer Community Hospital) (Office of the Federal Register)(2011)."},{"key":"e_1_2_11_7_1","unstructured":"88 Medicare and Medicaid Programs;Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area (Renown Regional Medical Center)82375\u201382376(2023)."},{"key":"e_1_2_11_8_1","unstructured":"87 Medicare and Medicaid Programs;Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area (North Carolina Baptist Hospital)68160\u201368161(2022)."},{"key":"e_1_2_11_9_1","unstructured":"Organ Procurement Organizations Annual Public Aggregated Performance Report 2023. Accessed July 29 2026 https:\/\/www.cms.gov\/files\/document\/opo\u2010annual\u2010public\u2010performance\u2010report\u20102023.pdf."},{"key":"e_1_2_11_10_1","unstructured":"Medicare and Medicaid Programs;Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area (High Point Regional Health). Accessed March 9 2026 https:\/\/www.federalregister.gov\/documents\/2026\/02\/18\/2026\u201003110\/medicare\u2010and\u2010medicaid\u2010programs\u2010announcement\u2010of\u2010application\u2010from\u2010a\u2010hospital\u2010requesting\u2010waiver\u2010for."},{"key":"e_1_2_11_11_1","unstructured":"Medicare and Medicaid Programs;Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area(WRMC Hospital Operating Corporation) 7491\u20137492[2026\u201003111]. Accessed March 9 2026 https:\/\/regulations.justia.com\/regulations\/fedreg\/2026\/02\/18\/2026\u201003111.html."},{"key":"e_1_2_11_12_1","unstructured":"Medicare and Medicaid Programs;Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area(Alleghany County Memorial Hospital Inc.) 7493\u20137494[2026\u201003119]."},{"key":"e_1_2_11_13_1","unstructured":"Download as PDF. Accessed March 9 2026 https:\/\/regulations.justia.com\/regulations\/fedreg\/2026\/02\/18\/2026\u201003119.html."},{"key":"e_1_2_11_14_1","unstructured":"Medicare and Medicaid Programs;Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area(Hugh Chatham Memorial Hospital Inc.) 7990\u20137991[2026\u201003278]. Accessed March 9 2026 https:\/\/regulations.justia.com\/regulations\/fedreg\/2026\/02\/19\/2026\u201003278.html."},{"key":"e_1_2_11_15_1","unstructured":"Medicare and Medicaid Programs;Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area (Lexington Medical Center) 7991\u20137992[2026\u201003277]. Accessed March 9 2026 https:\/\/regulations.justia.com\/regulations\/fedreg\/2026\/02\/19\/2026\u201003277.html."},{"key":"e_1_2_11_16_1","unstructured":"S.Laird \u201cPrisma Health seeks split with SC organ transplant coordinator facing decertification \u201d (SC Daily Gazette 2026\/03\/09) https:\/\/scdailygazette.com\/2026\/03\/09\/prisma\u2010health\u2010seeks\u2010split\u2010with\u2010sc\u2010organ\u2010transplant\u2010coordinator\u2010facing\u2010decertification\/."},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.9.975"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.11.042"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16442"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16085"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70642","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70642","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70642","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:31:37Z","timestamp":1787679097000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70642"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/ctr.70642"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70642","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-03-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70642"}}