Fresh chapter also begins in brand-new, $14 million headquarters

by Wesley Brown – For Black people waiting on the Arkansas waiting list for a lifesaving heart, liver, kidney, pancreas or lung at the end of 2021, the chances of survival or getting an organ donation during the pandemic were becoming increasingly more difficult.

However, the Arkansas Regional Organ Recovery Agency’s (ARORA) newly hired CEO Mark Tudor — armed with a fresh directive and the agency’s brand-new, state-of-the-art headquarters in west Little Rock — said those days are well in the past.

In the midst of a remarkable turnaround that has kept ARORA from being decertified and possibly taken over by the federal government, the former senior operations executive for one of the nation’s best-run organ procurement organizations (OPOs) has not only changed the culture and performance at Arkansas’ largest OPO, but he is also looking to close the gap on the agency’s poor history in finding Black donors or getting transplants for the same.

“If you are African American, those are things that we have to continue to change as we continue to find [organs] and make those things equal,” said Tudor, hired by the ARORA Board of Directors in January 2022.

Still, about the same time that Tudor made the decision to take the top job at the beleaguered Little Rock nonprofit during the COVID-19 pandemic, Congress was implementing new rules to address health equity failures of the current organ donation system that disproportionately hurt patients of color.

In March 2021, the Biden Administration adopted new federal rules that retool kidney care in the U.S. and hold OPOs accountable for mediocre performance. And according to the U.S. Centers for Medicare and Medicaid Services (CMS) annual performance report that came out in October, ARORA ranked at or near the bottom for organ donation and transplantation rates among the 57 federally mandated OPOs.

According to CMS, which used the most recently available data collected from an independently reported Centers for Disease and Control (CDC) database of death certificates, ARORA is one of 16 OPOs classified as a Tier 3 OPO during this assessment period. Based on that data, the Little Rock-based nonprofit is listed among the worst OPOs in the U.S. for overall performance.

Under the new organ donation reform rules first introduced through an executive order signed by President Donald Trump in July 2019, CMS 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 106,000 people on the nation’s organ donor waiting list.

CMS has set up a three-tier system where all OPOs are assigned to one of 57 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 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 at or above the mean, but below the top 25th percentile for either the donation rate or the transplantation rate. Tier 2 OPOs can be recertified but their service area will be open to competition from Tier 1 performers.

Tier 3 OPOs such as ARORA perform below the mean for either the donation or the transplantation rate, and those OPOs will be subject to a decertification process. In the future, OPOs will be on a four-year certification cycle through 2026, with an annual assessment starting in early 2023.

ARORA’s remarkable recovery

And although the CMS report noted that the Arkansas OPO would need to increase its organ donation rate by 37 persons annually to be released from Tier 3 status, many organ donation industry analysts predicted the worst for the Arkansas OPO. But that has all changed.

In 2019 and 2020, respectively, the number of deceased donors recovered in ARORA’s donation service area (DSA) was an unremarkable 64 and 63 total. At the end of 2021, ARORA’s performance spiked by nearly 59% to 101 donors. Through the first half of 2022, ARORA was already at 91 organ donors and is projected to end the year at 156, the highest tally of organ donors ever in the agency’s history.

Concerning ARORA’s transplant rate for those registered candidates needing a lifesaving organ, ARORA needed a whopping 96 additional transplants to reach Tier 1 status, based on 2019 data. The Little Rock-based nonprofit saw 212 and 218 transplants in 2019 and 2020, respectively, but improved substantially to Tier 2 level in 2021. With 195 transplants through the first half of 2022 and a projected 334 by the end of the year, ARORA would be just one transplant short of Tier 1 status.

Through the first half of 2022, Tudor said ARORA is solidly a Tier 2 organ donation agency. For those seeking a transplant of a lifesaving heart, kidney, liver, lung or pancreas, ARORA’s improvement is just as astounding as more lives than ever are being saved through the agency’s efforts and the support of local transplant partners, including UAMS, Arkansas Baptist Health and Arkansas Children’s Hospital.

With only nine months on the job, Tudor said ARORA’s culture had to undergo an immediate change, including ridding the Arkansas OPO of its “rule out” mentality and adopting a “wait-and-see” attitude when considering individuals and families as potential organ donors.

“So now we are approaching a lot more families. If someone is on the registry, we are honoring that gift. If someone is a potential referral for us, we approach that family and let them make the decision,” said Tudor. “So, we are actually looking at a lot more patients and giving them a lot more opportunities and pursuing a lot more.”

Black lives matter

Meanwhile, most Americans on the nation’s organ donation list are suffering from kidney failure. Black Americans are three times as likely to suffer from kidney failure as white Americans yet are significantly less likely to be put on the transplant waitlist and less likely to receive a lifesaving transplant even once they are, according to a recent bipartisan congressional report and other industry data.

Even when the death is referred to the OPO, research by the National Institutes of Health also shows that “[t]he odds that a family of a White patient was approached for donations were nearly twice those for a family of an African American,” running directly counter to the charge of OPOs to pursue every possible donor. When OPOs respond to cases involving Black families, research shows they provide wildly diverse levels of service than they do for white families.

In relative terms, of the 222 registered candidates on Arkansas’ organ donation waiting list in Arkansas, three people per month or 36 annually on average died before receiving a lifesaving transplant for a heart, kidney, lung, liver, pancreas or intestine, according to the new CMS report. About 60% of those deaths were Black organ donation candidates or people of color waiting for a lifesaving kidney, heart, liver, lung, pancreas, or intestine.

In his role as the new ARORA CEO and one of the nation’s top DE&I advocates among the nation’s 57 OPOs, Tudor admitted that the Arkansas OPO and organ donation and transplant industry has a long way to go in providing better care and access to African Americans and other minorities. He noted that Arkansas has no lung or pancreas transplant program and only one heart transplant program.

“So, if you are someone in Arkansas, you have to travel outside the state of Arkansas just to find that type of care, and a lot of people can’t afford it,” he said. “First of all, they can’t afford it financially, and they can’t afford the social aspect of going to the transplant center and [having] no support system. It’s just not a fair system, and it is not equitable for everyone.”

Tudor also noted that Black people are most likely to die or need an organ transplant due to kidney failure but are generally not educated about kidney transplants until after dialysis.

“Black people have a one out of 5 more likely chance of having kidney failure, but yet they are not educated about transplant until after they’ve had dialysis,” he said. “For the average [white] person, they are educated prior. They can get on the list earlier and start accumulating time.”

In addition to improving organ and donation transplantation rates for Black and minorities across 64 of the 75 counties that ARORA serves in Arkansas, Tudor has made management and staff changes that reflect the growing diversity of the local population and people the agency serves.

For example, Arkansas’ 2020 Census data shows that Little Rock and Arkansas’ population base is substantially more ethnically diverse than a decade ago. The Census Bureau’s so-called diversity index also notes that the chance of two people chosen randomly from different racial or ethnic groups in Arkansas increased to 61.1% in 2020 from 54.9% in 2010. 

Against that backdrop, ARORA has also faced allegations of racial discrimination over the past several years, which several current and former employees say is linked to the agency’s overall deficient performance under Cochran and three other CEOs going back nearly a decade.

Only weeks after Cochran took office in late 2014, the agency’s former CFO Felicia Bowman filed a racial discrimination lawsuit in federal and local courts alleging a long-held culture of systemic bias and lack of promotions for Black employees at ARORA. Cochran responded by demoting and firing the agency’s lone top Black executive, who later lost her lawsuit before a Pulaski County jury in October 2017.

After Cochran stepped down at the end of 2021, Tudor came to ARORA only three months after he was elected national president of the Association of Multicultural Affairs in Transplantation (AMAT). Founded in 1991, the group supports minority transplant and procurement professionals that play a critical role in the nation’s dollar transplant system.

Tudor said he recently sent two employees to a DE&I training retreat over the summer and is considering hiring a diversity and equity specialist for the agency’s staff. As those changes are implemented, the Michigan native said he hopes to share ARORA’s DE&I success stories with other OPOs as a testimony for the necessity of diversity and equity for the industry’s success.

“At some point, we want to present our plan for DE&I initiative and let [people] know how we did that. We know that we had nothing, minimal [happening] at ARORA,” he said. “I hope by this time in two years, we are a model for the industry.”

New headquarters and new attitude

As ARORA undergoes its own cultural shift with major staff and operational changes with new diversity and equity training, the agency is also changing its appearance and location. Over the past year, ARORA has undergone a companywide marketing rebrand with the assistance of Little Rock-based marketing firm Thoma Thoma that includes a fresh look, a new logo and website, and revamped mission statement. Earlier this year, ARORA also moved from its former location on Kanis Road in west Little Rock to its nearby, brand-new $14 million [checking to make sure this number is accurate] [1] headquarters that was planned ahead of Tudor’s hiring.

During his first nine months on the job, the former senior director of OPO operations at LifeNet Health in Virginia Beach, Va., has also put together his own internal management team. Tudor said the local nonprofit with nearly 100 employees is still looking to fill key positions due to the agency’s past high turnover rate and key changes to the clinical and organ donor services staff.

Acknowledging that he has made some difficult staff decisions to get the agency’s performance back on track, Tudor did not provide details of any firings or resignations but said what he is most proud of is that “ARORA looks like the people we serve.”

“Any time there is change, it is hard to go through. And being a new CEO, I wanted to make sure that I had to build my new team. And that’s what I am doing and the people that I am bringing are full of energy because I am a high-energy kind of guy,” said Tudor.

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