New CMS reports shows ARORA’s organ donation rate is worst in the nation

October 18-24, 2021

By Wesley Brown


As the 12-person board of the Arkansas Regional Organ Recovery Agency concludes its national search to replace its current chief executive, a new publicly available report released by the U.S. Centers for Medicare and Medicaid (CSM) shows the performance of the state’s largest organ procurement organization (OPO) is worse than previously thought.


According to new outcome measures for OPO performance that went into effect on March 30, 2021, CMS reported that ARORA’s donation rate for deceased organ donors is dead last out of the 56 federally mandated OPOs in the U.S. At the same time, the Little Rock-based OPO’s standard transplantation rate for candidates on the state’s organ donor waitlist is third-to-last among the same OPOs.


In relative terms, of the 214 registered candidates on the organ donation waiting list in Arkansas, three people per month or 36 annually will die before receiving a live-saving transplant for a heart, kidney, lung, liver, pancreas or intestine, according to the new CMS report released publicly on Oct. 7. That new data comes as ARORA’s board has completed a final round of interviews for candidates to replace agency President and Executive Director Alan Cochran, who announced his retirement at the beginning of the year.


Although ARORA Board Chairman Seth Heldenbrand told The Daily Record in an Oct. 4 story that the agency’s board was pleased with Cochran’s performance despite the agency’s failing grade, the timing of his retirement mirrors the implementation of new federal OPO reforms that he and other agency board members actively lobbied against.


In fact, the newly released data shows ARORA’s performance would have to substantially improve for the Little Rock organ donation group to escape decertification under the new OPO reforms rules that go into effect in 2022. Once in place, OPOs will be evaluated annually on their outcomes based on two primary components of operational work that ARORA is at or near the bottom -- organ donation rate for deceased donors and standard transplant rate.


Today, OPOs are responsible for working with hospitals to identify eligible deceased donors, obtaining authorization and testing donors for medical suitability, recovering organs, allocating organs to patients, and delivering them to transplant centers. There are three organ transplant centers in Arkansas that work with ARORA and perform organ transplants. Arkansas Children’s Hospital performs heart and kidney transplants; Baptist Medical Center performs heart transplants; and UAMS performs kidney and liver transplants.


Under the new rules, each OPO must work to increase the procurement and utilization of organs available through deceased donation by changing the metrics used and process for evaluating and certifying OPOs for participation in Medicare and Medicaid. They must now also correct issues identified in surveys to continue receiving Medicare and Medicaid reimbursement, which fund most agency operations.


CMS has set up a three-tier system where all 56 OPOs are assigned to one of 56 geographically based donation service areas (DSAs) and rank 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 transplantation rate. Tier two OPOs can be recertified yet their service area will be open to competition from Tier 1 performers. Going forward, OPOs will be on a four-year certification cycle through 2026 with an annual assessment period.


Based on 2019 data, ARORA would need to increase its organ donation rate by 37 persons annually. In 2019, the number of deceased donors recovered in ARORA’s donation service area (DSA) was 58 compared to 61 in 2020. Through the end of September, ARORA was well ahead of year ago levels at 65 but would still see a substantial spike in the final three months of the year to move out of Tier 3 status.


Concerning ARORA’s transplant rate for those registered candidates needing a life-saving organ, ARORA would need a whopping 96 additional transplants to reach Tier 1 status.  The Little Rock-based nonprofit saw 192 transplants in 2019, 204 in 2020, and has improved to 197 through the first three quarters of 2021. According to CMS, ARORA is among the worst performing eight OPOs in Tier 3 that would be subject to de-certification or loss of DSA because they would need to increase their donation and/or transplantation rates by more than 50% to meet the Tier 1 threshold rates.


“These eight are at the most serious risk,” CMS officials said in the 217-page narrative highlighting the new OPO reforms.



ARORA board remains silent on new executive director, possible leadership changes


In response to questions from The Daily Record concerning ARORA’s predicament, Sen. John Boozman expressed concern for the potential transplant candidates and donors in Arkansas. Today, ARORA serves 64 of the 75 counties in Arkansas. The eleven other counties in Arkansas are served by Mid-America Transplant Services of St. Louis; Southwest Transplant Alliance in Dallas; and Mid-South Transplant Foundation in Memphis.


In July, a coalition of congressional leaders from the Senate Committee on Finance and the House Committee on Oversight and Reform commended the Biden Administration for finalizing a rule to reform the organ procurement system under an executive order first put in place by former President Donald Trump in late 2019. That same Senate panel also urged the administration to explore additional ways to accelerate the accountability of underperforming OPOs, such as Tier 3 performers ARORA and Mid-South in Memphis, which serves six counties in Northeast Arkansas.


“As CMS moves forward with the implementation of new rules for organ procurement organizations (OPOs), we must make sure the agency follows through with the goal of ensuring uninterrupted coverage in the event an OPO is decertified so transplant candidates and donors continue being served,” said Boozman.


Media representatives for Rep. French Hill, R-Little Rock, and Sen. Tom Cotton, R-Little Rock, did not immediately respond to requests for comment from The Daily Record. Longtime ARORA Board Director Sarah Patterson, an attorney with Friday, Eldredge & Clark law firm, is the sister of Sen. Cotton.


ARORA’s other eleven board members, including top healthcare executives and local business leaders, also did not respond to inquiries concerning ARORA’s operations, Cochran’s dismal performance as CEO, and the board’s process for hiring a new executive director. Dr. Robert Archer, chair of the Department of Neurology in the College of Medicine at UAMS, is the former ARORA chairman that oversaw the hiring of Cochran in 2014. CARTI CFO Jennifer Styron, and Baptist Health-Little Rock President Greg Crain are former and current ARORA board members, respectively that were involved in the hiring process. They did not respond to requests for interviews.


Despite ARORA’s silence, CMS officials said in most cases of potential loss of certification, federal regulators would reasonably expect another Tier 1 OPOs such as Mid-America or Southwest Alliance to take over that service area of an underperforming OPOs like ARORA or Mid-South while retaining the original staff “but changing the leadership and many of the organ procurement practices.”


“Conversely, it is also possible that an OPO taking over a new service area would need to increase its staff or incur costs related to retraining, or implementation of best practices unfamiliar to the de-certified OPO’s staff,” CMS stated in its recent report. “We asked for comments on the costs associated with an OPO entering a new DSA after a decertification, including retraining, leadership, relationship building, and implementation of other best practices, but received no comments with which to inform our estimates. As indicated previously in this analysis, we have assumed disruption costs to OPO organ procurement practices will be mainly related to replacement of Chief Executive Officers and/or Boards and Board members.”


In addition, CMS stated that OPO boards also have the choice of replacing ineffective leadership and the new leaders could replace unproductive coordinators and managers. Tier 3 board members could also work to improve working relationships with donor hospitals within their service areas through programs such as the Workplace Partnership for Life, a federal Health Resources & Services Administration program that connects OPOs to community partners that program organ donation.


Through that program, ARORA has signed up more than three dozen community workplace partners across the state, including such corporations as First Security Bank, Nabholz Construction, and Steve Landers Toyota. The City of Little Rock, as well as Fort Smith, Searcy, Bryant, Siloam Springs, and North Little Rock are also partners with the beleaguered Arkansas nonprofit to promote organ donation registration.


“Should cases arise where an OPO is unable to make the necessary changes or is constrained by circumstances beyond its control so that it cannot reach the performance levels of others, CMS can intervene with technical assistance or to facilitate mergers or other changes,” CMS officials said. “The three-tier system put in place by this final rule will facilitate OPO decisions on corrective actions calibrated to their performance tier. We believe that every OPO can meet these standards through good faith reforms to improve both donation and organ placement.”


Meanwhile, ARORA plans to soon announce a new executive director to replace Cochran, a former tissue bank executive who joined the agency in 2014. One human resource consultant familiar with ARORA’s national search that began this summer said more than two dozen candidates applied for the position but only a handful came to Little Rock for an interview with the ARORA board.


Whoever takes over as the fifth ARORA chief in seven years will have only a brief window to improve the agency’s failing performance. 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.


Despite ARORA’s underperforming status, especially among Black organ donors and transplant candidates in Arkansas, Cochran’s total salary and compensation in fiscal 2019 was $272,271, including base pay of $223,622 with a 10.5% bonus of $23,625, according to ARORA’s 990 tax filings. To view the new CMS report on ARORA and other organ procurement agencies, go here:   


  • ARORA Board Director Dr. Robert Archer
    ARORA Board Director Dr. Robert Archer