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Regional organ donation group LifeSource downgraded to 'failing' in federal rankings

In a federal review, the Minneapolis-based organ procurement organization serving Minnesota and the Dakotas has fallen from a designation of "underperforming" to "failing." The organization says the slip reflects an off year due to the COVID-19 pandemic and that it is expanding its clinical staff. The review is designed to shorten the nation's organ waitlists. If LifeSource remains at the same level in 2026, it will lose its certification.

LifeSource
LifeSource is an organ procurement organization based in Minneapolis.
Joe Ahlquist/Joe Ahlquist
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ROCHESTER, Minn. — LifeSource, the organ transplantation organization for Minnesota, the Dakotas and western Wisconsin, has dropped below a critical threshold in a federal review designed to shorten organ waitlists, although a top executive says the change is based on "an anomaly" due to the COVID-19 pandemic.

According to the review, contained in an annual report released by Centers for Medicare and Medicaid Services earlier this month, the 33-year-old Minneapolis based nonprofit has been downgraded to a bottom-level, Tier 3 status termed as "failing."

The downgrading has no immediate consequences for LifeSource, one of what's known as an Organ Procurement Organization. But organizations that rank within Tier 3 at the end of the current contract in 2026 will lose their certification.

Since 2021, the OPO Annual Public Aggregated Performance Report has ranked the nation's donor organizations according to a complex formula evaluating their ability to enlist eligible donors and arrange for the transplantation of organs compared to other such organizations. Due to reporting delays, the reports draw on two-year-old data.

LifeSource was joined this year by 21 other organizations deemed to be "failing." The rankings were not announced formally, but CMS posts them publicly at the end of the first quarter. The next ratings, due by April of 2023, will reflect data from 2021.

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"The 2022 OPO Annual Performance Report assesses performance in 2020, and that year was an anomaly for LifeSource," says LifeSource Chief Strategy Officer Susan Mau Larson in a statement. "This is evident when placed in the context of performance prior to 2020 and since." Mau Larson said LifeSource had its best year to date in 2019 and "began 2020 on a strong trajectory of increasing donation."

LifeSource investigation by Forum News Service
More about Lifesource
Organ Failure: In the first of a three-part series, using more than 60 hours of interviews, the Rochester Post Bulletin explores why organ procurement organization LifeSource is underperforming and under investigation.

"Donation in our region was severely impacted by the pandemic," the statement continued. "In 2021, donations in our service began to increase and that has continued into 2022." Mau Larson says LifeSource anticipates caring for 268 donors in 2022, "which is a 30% increase above the highest year in our history."

CMS, which compares the nation's 57 OPO organizations to each other, drew on data from 2019 at the time of its first comparative performance evaluation, a 2021 Report in which LifeSource garnered 38th place out of what was then 58 organizations studied, the bottom position in Tier 2 . Since then, LifeSource has fallen from 38th to 46th place in the new report.

CMS says that the OPO would have needed to increase its performance by 12 donors or 72 organs in the 2021 analysis to reach the median, and by 45 donors or 164 organs to reach the top 25% of all OPOs.

Programs faced first evaluation in 2021

In 2019 CMS issued a report stating that the OPO system lacked objective metrics, transparency, accountability and incentives for improvement.

The program was launched to address a 400% performance differential between high- and low-performing organ procurement organizations nationally, leading to charges that the system was only capturing one-fifth of the donor potential, exacerbating waiting lists unnecessarily.

"COVID has been shown to cause organ failure, and experts project the pandemic will drive a massive spike in the need for transplants," said Greg Segal, Co-founder of ORGANIZE, a nonprofit that advocates for shorter waiting lists for transplant recipients. "So for OPOs like LifeSource to have gotten worse in 2020 is truly catastrophic for patients."

Segal says its not universal that low performance emerged from the pandemic, citing research finding that despite an early-year dip, 2020 set an all-time high for organ transplants nationally, one driven by an increased potential donor pool due to record "deaths of despair," the term for drug overdoses and suicide.

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Little objective, internal data is available on what separates OPO's who perform well from those who perform poorly, but academic studies argue that staffing, leadership and communication all play a role.

A 2020 Commentary in JAMA noted that leadership changes have made large changes in OPO performance elsewhere, citing a doubling of donors following such changes in Washington and Oklahoma, and a 40% increase following new leadership in South Carolina. A 2017 study has noted communication differences in low- and high-performing organizations, while other research has specifically noted the need for OPO's to better communicate with Black families.

LifeSource hired 39 new staff last year, according to Mau Larson, including 26 in clinical operations. Of the 29 hires in 2022 thus far, she said, 23 are in clinical roles. The clinical staff is now risen 15.2% "since the start of 2021," she says and the organization is currently undergoing an executive search following the retirement of its CEO, who "was able to assess our programs and develop a strong, long-term plan," according to Mau Larson.

"Consequently, we are on track for a record-breaking year in donation and well-positioned to attract a new CEO who shares our commitment to constant improvement, growth, and innovation in organ donation and transplantation on behalf of the people of Minnesota, North Dakota, South Dakota and western Wisconsin."

Paul John Scott is the health correspondent for NewsMD and the Forum News Service. He is a novelist and was an award winning magazine journalist for 15 years prior to joining the FNS in 2019.
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