Prisma Health is looking to switch from We Are Sharing Hope, based in Charleston, to LifeShare Carolinas, in Charlotte, for its organ donation services. (Photo by Getty Images)
COLUMBIA — One of South Carolina’s largest hospital systems wants to part ways with the state’s only nonprofit overseeing organ transplants after a federal rule change put the organization at risk of losing its certification.
Prisma Health is asking the federal government for permission to switch its organ transplant services to LifeShare Carolinas, which is based in Charlotte. Permission from the U.S. Department of Health and Human Services would sever ties between a dozen hospitals and We Are Sharing Hope, a Charleston-based nonprofit that coordinates organ donations for all but two of the state’s counties.
“Ultimately, it’s a business decision,” said Tim Brookshire, CEO of Prisma’s Greenville Memorial Hospital. “It’s what’s best for the patients and community.”
Prisma Health hasn’t had any specific issues working with Sharing Hope, said Brookshire, whose hospital led the request to switch providers. Instead, hospital officials recognized that LifeShare Carolinas received more organ donations, successfully transplanted more organs and charged less for its services last year.
With Sharing Hope at risk of losing its ability to oversee organ transplantation altogether this year, Prisma Health decided to set the change in motion just in case that comes to pass, Brookshire said.
The 56 organ procurement organizations nationwide are responsible for discussing donations with families whose loved one has died, finding recipients for donated organs, transporting the organs there safely, and supporting both the donor’s family and the patient who receives the organ after transplantation.
The nonprofit that coordinates organ transplants in SC could fold under federal change
Sharing Hope could survive the change, said David DeStefano, the nonprofit’s president.
But it would mean losing nearly a third of its total business. None of the state’s other major hospital systems have publicly made moves toward another provider, he said.
“I think we would be diminished,” DeStefano said. “But more importantly, I think the service to the people of South Carolina would be diminished.”
The four-year certification cycle the federal Medicaid agency is using to gauge the nonprofits’ performances will end July 31. If the agency finds Sharing Hope’s metrics haven’t significantly improved by then, the nonprofit could lose its ability to coordinate organ transplants, following an appeals process and pending any changes that come out of an ongoing lawsuit.
Sharing Hope ranks among the worst organ procurement organizations in the country under a 2022 federal rule, while LifeShare Carolinas ranks among the best.
The numbers speak for themselves, Brookshire said.
In 2023, families in Sharing Hope’s counties agreed to donate just over 9% of organs considered eligible, according to the most recent federal review available. LifeShare Carolinas, on the other hand, facilitated the donation of 20% of qualified organs, the review found.
Sharing Hope’s transplant rates also lagged behind their northern neighbor. The South Carolina-based nonprofit oversaw the transplant of just over a quarter of eligible organs, while the North Carolina nonprofit’s rate was nearly 60%.
Along with performing better, LifeShare charged less for its organs.
On average, Sharing Hope charges $62,500 for each kidney and liver, compared with around $57,000 for the same organs coordinated by LifeShare — a difference of more than $5,000 every time the hospital performs a transplant, according to data included in the waiver.
Sharing Hope has made strides toward improving its numbers over the past year, DeStefano said.
But it remains among the 10 organizations that could lose their certification because of the federal rule change, which was meant to introduce more accountability and competition among those overseeing organ transplants, according to the federal agency.
If Sharing Hope did lose its license to coordinate organ transplants, that would open up a mad dash for other organizations across the country to take over the process at the state’s hospitals.
Prisma wanted to get ahead of that to make sure it could partner with a nearby, high-performing coordinator, Brookshire said.
“This was the right thing for South Carolina and the right thing for the community that we serve,” Brookshire said.
Along with better data, LifeShare would bring other benefits, he said, including a closer proximity to the Upstate hospital than Charleston-based Sharing Hope.
That matters because one of the factors considered in the complicated calculations of who can receive an organ is proximity. If two patients qualify for an organ, it will go to the closer one, even if the person farther away has been waiting longer, said Carlos Zayas, medical director of Prisma’s kidney transplant program.
Partnering with LifeShare Carolinas could therefore help get more organs to patients in the Upstate, he said.
Having a provider nearby helps patients and donors’ families, too, Brookshire said.
Coordinators most often arrive in a moment of devastation for a family. Because organs used for transplants must be free of diseases or other health concerns, many come from young people who died in sudden and tragic ways.
Once a transplant is complete, staff stay in touch with the patients on both sides. They tell grieving loved ones where the organs went and help them get in touch with the transplant recipient if both sides so choose.
The organizations also typically host events and offer counseling services for the donor’s family.
Prisma’s hope is that LifeShare’s coordinators would be able to arrive in “a very timely manner to support those families while they are making the decision to donate.”
Not all of LifeShare’s work may translate to South Carolina, Brookshire said.
Hospital and organ transplant leaders are talking about how differences in cultures and outcomes between the two states could cause organ donation and transplantation rates to differ.
Brookshire wouldn’t expect a major drop-off in the quality of a person’s care just because of 100 miles, he said.
“It is not just a state lines conversation,” Brookshire said.
Sharing Hope’s leaders disagree. DeStefano contended that anyone from another state couldn’t understand the culture and nuances of South Carolina’s communities.
The nonprofit has members of its 150-person staff stationed all over the state, including in the Upstate, who are able to arrive quickly in emergencies and follow up with families throughout the process, he said.
“I think it is better for us to have an independent nonprofit entity living in the state, focused in the state, incorporated in the state, that truly serves the state and not have those resources go out of state for any reason,” DeStefano said.
Nothing will change right away. The fastest decisions on these sorts of waivers still typically take at least a year, and many go on much longer, Brookshire said.
In the meantime, Prisma hospitals will continue to work with Sharing Hope.
As part of the waiver process, Sharing Hope will have a chance to argue its case. Sharing Hope’s leaders contend the nonprofit remains the best choice for organ donations in the state.
“I think we’re a clear choice to continue that work,” DeStefano said.
DeStefano argued the numbers don’t truly represent the nonprofit’s work. South Carolina is at a disadvantage federally because of a lack of health care that leads to unhealthier patients and, thus, fewer organs viable for donation, he said.
Sharing Hope is part of a federal lawsuit arguing the federal rule turns the system “into a cutthroat, iterative Hunger-Games-style competition where only the top are guaranteed ‘organizational survival.’”
The South Carolina nonprofit and two other organ procurement organizations, all at different tiers under federal standards, are trying to overturn the rule and keep the lowest-performing nonprofits from closing.
Hospital administrators can’t say whether the numbers are fair, Brookshire said.
Fair or not, Sharing Hope losing its certification while still coordinating for Prisma Health could create turmoil for the hospital system’s organ transplant center, he said.
“I don’t think that it’s fair to South Carolina or fair to Prisma Health or the patients that we serve to let the federal government go through with that,” Brookshire said.
Scanned DocumentCourtesy of South Carolina Daily Gazette
