When a patient is on their deathbed and their next of kin are notified, doctors often make another, more discreet call to LiveOn New York, a nonprofit with exclusive rights to retrieve organs for donation in the New York City region.
For years the Long Island City-based group was consistently cited among the lowest-performing organ procurement organizations in the country by the federal Centers for Medicaid and Medicare Services. It was regularly at risk of losing its license, one of just four awarded in the state.
Since 2021, however, organ procurement data and tax records suggest the agency has turned a corner. The number of organ donors has nearly doubled, with revenue and headcount following suit. At the center of LiveOn’s success is an investment in ways to get family consent at the bedside of dying loved ones.
“You can’t have a recipient without a donor, so we refocused our strategy on not forgetting the donor,” said Leonard Achan, LiveOn’s president and CEO since 2021, who prefers to refer to organs as “gifts of life.”
Responsible parties
As a federally-designated organ procurement organization, LiveOn is responsible for obtaining and transporting any organ available in the 4,500-square-mile, 13.2 million-person jurisdiction surrounding the city, one of the most densely populated in the country. The most donated organs are kidneys, followed by livers and liver segments, but LiveOn also procures hearts, intestines, lungs and pancreases, along with skin, bone and other tissue.
In late 2020, its federal regulator created a new ranking system based on the number of organs procured and successfully transplanted; the next year LiveOn was placed in the lowest tier, meaning it would automatically lose its license at the end of the next four-year recertification cycle if it didn’t turn things around.
By 2022, things were looking up for LiveOn – the company had moved from the lowest tier into the highest, suggesting the organization is likely to retain its certification, which is up for renewal in 2026.
Before its turnaround, LiveOn spent a fraction of what it spends today on liaising with families, removing organs and coordinating delivery. Now, the operation depends almost entirely on building relationships with next of kin, embedding its staff in hospitals and trailing behind surgeons to make those connections. It’s working: In the 12 months ending in June 2024, the number of organ donors in LiveOn’s region reached 586, rising from just under 300 in 2020, according to the Scientific Registry of Transplant Recipients, a federally contracted database.
Only 20% of the organs LiveOn procures come from donors who joined the registry before they died, said Achan, a former ICU nurse who previously held C-suite and communications positions at Hospital for Special Surgery and Mount Sinai. The remaining 80% require a relative or another proxy’s signature, a tightrope walk for coordinators when an organ’s viability hangs in the balance of hours.
“There is some time pressure but also a recognition that if they push them too hard, the families may just back off,” said one former hospital executive.
Anguish is such an ingrained part of the business that it is written into its tax documents. In a description of its donor services, filings state LiveOn staff must thoroughly explain the process to families, “whose ability to process information is impaired by emotionally traumatic circumstances.”
LiveOn has credited the turnaround to its education of local elected officials and other messengers, donor hospitals and families to encourage donation. The nonprofit spent more than $8 million on government affairs and public education in 2023, its latest tax filings show.
That figure is dwarfed by the $63 million LiveOn poured into clinical care and getting consent for more organs, which rose from $34 million in 2019. Much of the new spending covers a growing staff headcount, up by 210 employees to 480, a 78% increase. LiveOn declined to say which positions were added or how many employees are specifically dedicated to family services.
Most of LiveOn’s revenue comes from reimbursements for the organs – procured from a family member or, less frequently, the donor registry – that LiveOn delivers to transplant centers. Organ procurement organizations typically pay hospitals to continue to care for a body after the patient is declared dead until their viable organs can be removed, according to two current and former hospital executives with knowledge of the process. Those costs are offset by payments, usually from government or private insurers on behalf of the receiving patient, and sometimes from the transplant center itself. Deceased patients and their families are not compensated.
LiveOn’s revenue nearly doubled, to $82 million, between 2019 and 2023, a significant leap in just five years, according to tax filings. Executive salaries have risen too: Achan earned more than $1.1 million in 2023, close to double his predecessor’s compensation and a 25% raise from the year before.
Advances in the field
In addition to its efforts to persuade family members to donate a dying loved one’s organs, LiveOn is benefiting from technological developments that make organs last longer.
So-called perfusion machines that pump organs with blood and other fluids can now keep them viable outside the body for longer, sometimes by a matter of days. That has given doctors more flexibility to assess organs, attempt transplants and even make additional offers if a planned recipient becomes ineligible, said Dr. Nabil Dagher, director of the Transplant Institute at Northwell Health, one of the biggest transplant programs in the state.
Perfusion has also allowed doctors to take organs directly from patients whose blood flow has completely stopped without losing critical time to transplant them. Traditionally, donated organs came from patients who are brain dead, when the body is considered legally deceased but can still sustain organ function. But perfusion has made more patients viable donors even after their blood stops pumping. That has led more donations to come from patients who were taken off life support until their heart stops – a state known as cardiac or circulatory death, Dagher said.
In New York, the number of people who became organ donors after cardiac death has grown dramatically. Downstate, in LiveOn’s realm, 220 donors, or 38%, entered the transplant system this way in 2024, up from 29% of all donors the year before.
Hard truths
More than 1,300 organs were transplanted in LiveOn’s jurisdiction last year, according to the Scientific Registry of Transplant Recipients, giving people around the country another chance to live.
“It’s very difficult to explain that to the family,” said one trauma surgeon who works at a safety-net hospital in Brooklyn.
But the message is getting through, Achan said. “New York’s community has really risen to the occasion over the last three years to do this.”
