Issue: May 2022
Disclosures: Nathan reports no relevant financial disclosures.
May 18, 2022
3 min read
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In retirement, Gift of Life Donor Program CEO discusses success, ways to increase donation

Issue: May 2022
Disclosures: Nathan reports no relevant financial disclosures.
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Howard M. Nathan retired earlier this year after 38 years of leading one of the largest and most successful organ procurement organizations in the country.

His run as CEO of the Gift of Life Donor Program – he started as a transplant coordinator – contributed to the procurement of more than 55,500 organs for transplant by the organ procurement organization (OPO) since 1974.

Data from the United Network for Organ Sharing (UNOS) verifies Nathan’s success, showing that, since 2008, the Gift of Life Donor Program identified the most organ donors every year among 57 OPOs in the United States. The program coordinated delivery of organs from 705 organ donors – the most in the U.S. last year –, UNOS reported. That donation led to 1,732 transplants, including 1,007 kidney transplants, the most among OPOs in 2021.

The Gift of Life Donor Program serves the eastern half of Pennsylvania, Southern New Jersey and Delaware.

Howard M. Nathan

Nathan was appointed executive director of the Gift of Life’s Transplant Foundation after he stepped down as CEO. The foundation leads research and education advances in donation advance donation and transplantation around the world.

He spoke with Nephrology News & Issues about his success at Gift of Life and what needs to be done to increase organ donation in the United States.

Nephrology News & Issues: What were key steps you implemented that helped to increase organ donation?

Howard M. Nathan: If you go back 25 years, Gift of Life was one of the first programs to institute donation after circulatory death (DCD). We helped educate more than half the OPOs about DCD back in the 1990s and 2000s. Now, DCD donors represent about 30% of all the donors in the United States. So, it was a niche that turned into something commonplace. DCD started as an initiative for kidneys, then livers, lungs and now even hearts have been procured and preserved.

Nephrology News & Issues: What challenges ahead do you see for OPOs?

Nathan: The biggest challenge is the perception that there are a lot more perfect organ donors available. But not all donors are 16-year-old kids in car accidents, as the public perceives. That represents less than 15% of organ donors.

Most of the donors look like us: old, hypertensive, diabetic. So, the challenge is using these organs – what we would call in the old days “expanded donor kidneys” – and getting them transplanted in patients that look like us.

The people that are on the [wait]list who are 60 years old to 70 years old and older and need a kidney — Why should surgeons turn older kidneys down for transplant in these patients? What we have experienced as we have become more assertive and aggressive in accepting older donors is that they tend to be ‘sicker,’ but their kidneys work.

Nephrology News & Issues: Are organs being shared locally first?

Nathan: On a local level, the new UNOS allocation guidelines can create a problem, in my opinion. Your local surgeons do not get the first opportunity to use [expanded donors], so you have to share them in a 250-mile radius. That makes it a little harder to get the patient cross matched, tissue typed, and then you have to worry about the cold (ischemia) time for the donated organ, and the length of the time out of the body gets extended. If the older donor [organ] time gets extended, they may get discarded.

So, our challenge is to get transplant centers to use these expanded kidneys.

Nephrology News & Issues: Will the new OPO performance measures increase the number of donated organs?

Nathan: Certainly, improvements in organ donation to utilize best practices is a good idea. The new CMS guidelines are aimed at improving all OPOs across the United States, which will be instituted by 2026. I think many OPOs have been improving over time.

But living donors have the ability to help solve the [organ shortage] problem, too. The number of deceased donors that exist is limited every year. There should be a national collaborative on living kidney donation to make it more organized so centers have the capacity to evaluate living donors and get them transplanted.

In some places they are efficient and focused, and in some places it takes a longer period of time. So those kinds of best practices need to be shared, in addition to getting more deceased donors.