ARORA hires new executive director as agency faces uncertain future
November 22-28, 2021
By Wesley Brown
The Arkansas Regional Organ Recovery Agency (ARORA) has hired its fifth executive director in seven years as the state’s largest organ procurement organization (OPO) seeks to stave off decertification and improve the nation’s worst rating in harvesting life-saving organs from deceased donors.
According to details of the national search process obtained by The Daily Record, the ARORA board of directors last week officially announced the hiring of Mark Tudor as the new executive director of the state’s largest federal mandated OPO that serves 64 of the state’s 75 counties. Tudor previously served as a senior director at LifeNet Health in Virginia Beach, Va., and Gift of Life Michigan in Ann Arbor, Mich.
Tudor will replace current ARORA Executive Director and President Alan Cochran, who announced plans to retire in early 2021 just before the Biden administration announced new Trump-era OPO reform rules that revamp how the nation’s 57 OPO operate and procure life-saving hearts, kidneys, lungs, pancreas, livers and intestines.
In his most recent job, Tudor served as the senior director of operations at LifeNet and has more than 25 years of experience in the organ donation industry. Tudor received his Bachelor of Science degree from Bowling Green (Ohio) State University and his Master of Strategy and Leadership degree from Michigan State University in Lansing, Mich.
Tudor did not immediately respond to media inquiries from The Daily Record concerning his new job with the Arkansas organ donation group. ARORA Board Chairman Seth Heldenbrand and other members of the agency’s 11-person board also did not respond to questions about Tudor’s start date and any operational changes he may undertake.
In taking over the ARORA’s day-to-day operations, Tudor will only have a brief window to improve the agency’s overall performance in procuring organ donations before pressure mounts for the agency’s board to consider a merger or takeover of the Little Rock nonprofit by a larger out-of-state OPO.
Under the new organ donation reform rules first introduced in an executive order by President Trump in July 2019, the Biden administration in March adopted federal mandates that have received broad bipartisan support to retool kidney care in the U.S. and hold OPOs accountable for inferior performance. The U.S. Centers for Medicare and Medicaid Services (CMS), which regulates the nation’s OPO system, has estimated the U.S. could increase the number of organs available for transplant by 5,600 per year and that the annual number of transplants performed could increase from approximately 33,000 to 41,000 by 2026. There are currently about 108,000 people on the nation’s organ donor waiting list.
Under the CMS’s new three-tier system, all 57 OPOs are assigned to geographically based donation service areas (DSAs) and ranked based on how they do under both that donation rate and the transplant rate. Tier 1 will be composed of OPOs that are at or above the top 25th percentile for both the donation rate and the transplant rate during the assessment period.
Tier 2 OPOs are agencies that are at or above the mean, but below the top 25th percentile for either the donation rate or the transplant rate. Tier two OPOs can be recertified yet their service area will be open to competition from Tier 1 performers. Tier three OPOs are those that perform below the mean for either the donation rate or the transplant rate, and those OPOs are going to be subject to a decertification process. Beginning in 2022, OPOs will be on a four-year certification cycle through 2026 with an annual assessment period.
Based on 2019 data, ARORA is among the nation’s worst performing Tier 3 OPOs and would need to increase its organ donation rate by 37 persons annually to remain in compliance. Like most OPOs, data from the federal Scientific Registry of Transplant Recipients database shows ARORA has seen a small spike in organ donations in the past five years, but substantially all those gains are related to the nation’s epidemic of opioid and COVID-19 deaths not any operational changes at the Arkansas nonprofit.
Meanwhile, ARORA will now be seeking to get a fresh start under Tudor that guides the agency back toward its charitable mission of organ donation. Under Cochran’s helm, ARORA has mostly focused on the profit-making tissue donation industry, which is separated from the procuring of life-saving organs for transplant candidates on the nation’s organ donation waitlist. In fact, ARORA’s organ donation coordinators do not alert most donor candidates and families that only 3 in 1,000 people die in a way that allows for deceased organ donation.
Also, a large portion of ARORA’s $13 million-plus budget and 90-person staff is dedicated to harvesting non-saving skin, bone and tissue donations that can be used for plastic surgery, nose jobs, face lifts, breast and butt enhancements, and other cosmetic uses. Also, tissue donations harvested from deceased cadavers that have signed up for Arkansas’ organ donation waiting list can also be sold to cosmetic companies and publicly-traded tissue banks firms that test new bio-surgical products.
Another area of failure under Cochran administration has been the agency’s outreach to Black and minority organ donation and transplant candidates, which is the focus of a congressional investigation initiating new oversight into the root causes of racial disparity in the organ donation system.
In early 2015, Cochran spearheaded the agency’s case against former CFO Felicia Bowman, who filed a racial discrimination lawsuit in federal and local courts in 2015 alleging a long-held culture of systemic bias and lack of promotions for black employees at ARORA. In Pulaski County court filings, Bowman alleged that Cochran responded to her lawsuit by demoting and then firing the agency’s former top Black executive who later lost her lawsuit before a Pulaski County jury in October 2017.
Tudor is taking over a job with only a brief window to improve the agency’s failing performance before possible federal action. Once the new four-year certification cycle begins in January, CMS will review OPO performance every 12 months to ensure fewer viable organs are not wasted and more timely transplants occur. CMS officials said reviewing OPOs at least every 12 months and releasing those reports publicly would also allow CMS to more quickly identify OPOs that need improvement so action can be taken to implement needed changes.
Cochran’s leadership legacy
What is known about ARORA under Cochran’s tenure is that the agency is now the worst performing OPO in the U.S., based on several metrics. For example, CMS recently released its annual Organ Procurement Organizations’ (OPO) Aggregate Performance Report, ranking ARORA at or near the bottom for both organ donation rates and organ transplantation rates.
According to the public report, which utilizes the most recently available data collected from an independently reported CDC database of death certificates, ARORA is one of 16 OPOs classified as a Tier 3 OPO during this assessment period.
This is the first report released since CMS implemented new criteria for measuring OPO performance in the U.S., replacing the previous outcome measures and increasing competition amongst OPOs for donation service areas (DSAs) who do not meet expected performance thresholds.
In relative terms, of the 222 registered candidates on the organ donation waiting list in Arkansas, three people per month or 36 annually will die before receiving a life-saving transplant for a heart, kidney, lung, liver, pancreas or intestine, according to the new CMS report released publicly on Oct. 7.
For Black candidates waiting on a life-saving organ donation in Arkansas, the news is even more dire. As of Oct. 14, 95 of the 222 people on Arkansas’ organ donation waiting list are Black, compared to 90 white. Of that total, 83 Black candidates are waiting for a life-saving kidney transplant. Black patients in Arkansas also make up 43% of the patients on the state’s organ donation waiting list for a life-saving transplant, well above the 28.5% national average. That means that of the 36 people a year that die waiting for an organ transplant in Arkansas, 15 of those deaths are Black candidates on the waiting list most likely seeking a kidney transplant.
To his credit, Tudor has a strong background in corporate diversity, equity and inclusion and working with diverse populations. In late October, he was named board president of the Association of Multicultural Affairs in Transplantation (AMAT), an industry trade association that seeks to promote organ donation to people of color.
In August, AMAT and the Association of Organ Procurement Organizations, the national OPO trade group that is under congressional investigation, announced a national task to address the need for more organ donations and tissue donations within minority communities. In accepting his new role with AMAT, Tudor said his goal is to build partnerships, maintain organizational growth and set the standard in the Diversity, Equity, and Inclusion conversations.
“As a volunteer organization, AMAT is dependent upon membership and community support. We are excited to be able to participate in various Diversity, Equity, and Inclusion projects on local, state, and national platforms,” said Tudor. “In the next two years, my focus will be working towards increasing our membership by 25%. I am greatly looking forward to meeting each new member and figuring out how to make AMAT work for you.”
At LifeNet, a Tier 2 OPO, Tudor was also involved with a promotional campaign earlier this year that sought to build support for organ and tissue donation in the Richmond, Va., area. According to LifeNet officials, the so-called “One Hero” campaign blitzed Black and minority communities with information about the critical need for Black organ and tissue donors. It also addressed misconceptions around organ donation that have kept registration rates low in Black communities.
ARORA also promoted similar promotional campaigns in the past. However, shortly after Cochran was hired in late 2014, ARORA fired the agency’s long-time PR agency of record, the locally- and Black-owned The Design Group that won national recognition from AMAT for its efforts to increase organ donation among minorities.
Today, ARORA’s 11-person board includes two Black directors, including Arkansas Urban League Executive Director Scott Hamilton and Little Rock attorney Denese Fletcher.