Purpose of Review <p>Organ procurement organizations (OPOs) carry the responsibility of identifying and managing deceased organ donors and allocating organs from these donors. The transplant system includes multiple other independent organizations, including transplant centers, which the OPOs must collaborate with in pursuit of the shared goal of improving transplant access.</p> Recent Findings <p>Previous quality metrics for OPOs included donation rates per eligible death and aggregate donor yield, while transplant center metrics emphasized recipient outcomes. In an effort to better align OPO metrics with patient-centered outcomes, CMS changed the measures of OPO performance in 2021 to specifically define potential donor deaths and include transplant rate as a metric for the first time. Ensuing criticism of these changes included concerns that utilizing transplant rate as a metric for OPOs is not entirely under the control of the OPO, with upstream influence from donor characteristics and downstream influence from transplant center acceptance practices, but OPO operational practices do meaningfully influence organ utilization. While there are additional concerns that transplant rate as a performance metric may penalize OPOs with a higher risk tolerance, the absolute gains in volume from more aggressive donor pursuit appears to outweigh potential increases in discard or non-utilization.</p> Summary <p>Coupled with offer acceptance as a transplant center metric, utilizing transplant rate as an OPO metric better aligns patient-centered outcomes with OPO metrics and supports the overall goal of the transplant system: translating every viable organ into a transplant.</p>