A transplant lifeline is in jeopardy for Montana patients

Bigfork resident Todd Ware received the best gift of his life the day after Christmas 2020.

Critically ill and in need of a double-lung transplant, Ware predicted he didn’t have more than two weeks of life left when the call came telling him there had been a match.

Since that moment nearly six years ago, his life has been transformed, as he’s taken to the skies and the slopes, doing two things that he was unable to do for years because of his failing lungs — fly as a glider pilot and go skiing.

For hundreds of Montanans who are on an organ transplant list, the wait for a life-saving donor comes with the added difficulty of being hundreds of miles away from the nearest medical transplant center. Guidelines proposed by the Trump administration could mean the only organization coordinating transplant services in Montana might lose certification, leaving already sick patients with even fewer options.

That’s why Montana’s congressional delegation — four Republicans — signed onto a letter with other western states lawmakers asking the Trump administration to reconsider its decision.

Federal delegations, medical providers and advocacy groups said a change in how the government regulates organ transplants could have massive downstream impacts, potentially closing as many as half of the organizations that provide those services across the country.

The new rules, they add, are based on statistics they don’t control: for example, how many organ transplants an organization completes, which can vary by region and available medical expertise, and is a decision made by doctors, not transplant service providers.

Much of the West, particularly Montana, Alaska and Washington have few options for organ transplant care. Montana is one of four states without an organ transplant center and has just one provider of the service — LifeCenter Northwest, which is in Washington. It also serves Alaska and part of Idaho.

All four Montanans in Congress — Sens. Steve Daines and Tim Sheehy, and Reps. Troy Downing and Ryan Zinke — signed the letter, as did 13 others.

“The Trump administration proposed major oversight and accountability changes that will determine whether OPOs (organ procurement organizations) may continue operating during the 2026 recertification cycle,” Washington’s U.S. Sen. Maria Cantwell, a Democrat, said in a news release. “If these changes are finalized, it is estimated that approximately 75% of OPOs could be at risk of decertification.”

“Organ procurement organization” is a federal designation that allows organizations, like LifeCenter Northwest, to legally possess and transport human tissue and organs.

For Ware, the Bigfork man, getting a double lung transplant was a matter of life and death. 

He was diagnosed late in life with a genetic lung disease and then contracted pneumonia. Ware said his lungs were about 17% capacity when he got the call the day after Christmas that there was a match.

“I thought I had a matter of, you know, I’d be surprised if I could have lived two more weeks,” Ware said in an interview with the Daily Montanan. “That’s the number I gave myself.”

Ware made the trip to Seattle for the transplant, which went smoothly, he said. Montana hospitals generally do not do solid (e.g. heart, lung, kidney) transplants and instead these operations are done out-of-state.

New rules, big problems

The rules frustrating the delegations and LifeCenter Northwest deal specifically with how organizations are evaluated annually.

Certification rules from federal Health and Human Services and the Centers for Medicare and Medicaid Services rely solely on “two closely related outcome measures,” which the letter argues does not properly account for the challenges associated with serving a wide geographic area.

The letter asks HHS and CMS to reconsider “automatic decertification based solely on the current outcome-only, single-year tiering methodology.”

LifeCenter Northwest, like all organ procurement organizations, is evaluated on the number of organ donors for whom at least one organ gets transplanted and the number of recovered organs that get transplanted.

“This second metric is particularly concerning because OPOs do not decide whether an organ is transplanted,” LifeCenter Northwest said in a statement to the Daily Montanan. “Those decisions are made by transplant doctors at transplant hospitals.”

Amendments to recent federal rule changes around organ donorship are set to go into effect before the end of the year, which has caused widespread industry concern it could lead to significant disruption in patient care, according to Bloomberg. 

“CMS’s methodology ignores recommendations by experts and instructions from Congress to apply performance, as well as outcome measures, to ensure a more accurate and objective evaluation of OPO performance,” LifeCenter Northwest said in a statement, adding “population health differences, process measures, risk-adjusted performance” are accounted for in other healthcare programs overseen by CMS.

It’s also unclear when, exactly those rules will go into effect.

“CMS has not yet issued those final amendments,” LifeCenter Northwest said in a statement. “While no specific timeline has been provided, they are expected to be released in late 2026.

According to the American Journal of Transplants, potentially half of all organ procurement organizations could be at risk of closing due to the new rules.

“In conclusion, our analysis … found that 64% of the 58 OPOs would have failed the standards if the metrics were applied to calendar year 2017,” the article states.

Huge area with not many people.

More than 100,000 people nationwide are on organ donor lists. Last year, LifeCenter Northwest coordinated 1,318 organ transplants, which was 200 more than the previous year, according to the organization. That was a record.

LifeCenter Northwest services around 200 hospitals in its coverage area, and if it isn’t recertified, could leave Montana, Alaska and most of Washington without consistent organ transplant services.

The organization is the sole provider of the service in that area — which also includes 11 counties in Idaho — and spans more than 800,000 square miles and 10 million people.

There are only five transplant centers in the area covered by LifeCenter Northwest, all in Washington, and the organization relies heavily on aerial transportation and “narrow clinical timeframes,” according to the letter.

For Ware, LifeCenter Northwest opened his life back up again. He spent three months on the waiting list and said his experience with the organization was stellar.

“Life Center Northwest handled so much behind the scenes before I even got there. You know, I arrived and lungs were there,” Ware said. “Then later afterwards, you see the incredible process that it takes, and it’s not just miraculous that they can do the operation. It’s miraculous that they can synchronize me getting from Montana to Seattle and the organs coming in.”

CMS has increased oversight of the organ donor system under President Donald Trump. There’s been widespread organ shortages, which the Trump administration is also seeking to address.

But practical realities aren’t being taken into account, LifeCenter said, and CMS is treating their program differently than other healthcare providers.

“In other healthcare quality and performance programs, CMS accounts for factors that meaningfully impact outcomes, such as population health differences, process measures, risk-adjusted performance, and demonstrated year-over-year improvement,” LifeCenter said in a statement.

CMS says those changes deal with trust, and following a 2025 investigation into an organ procurement organization in Kentucky, federal Health and Human Services vowed to make changes.

CMS Administrator Dr. Mehmet Oz has claimed American’s trust in physicians decreased between 2020 and 2024 and said this was a way to “earn it back,” in a press release earlier this year.

The letter from members of Congress also asks for some consideration of the area’s unique circumstances and to provide LifeCenter Northwest a “clear pathway to demonstrate sustained, measurable improvement” before taking any decertification measures.

It goes on to say it supports evaluations grounded in “evidence based” measures, and that the current methodology doesn’t account for unique circumstances faced by rural healthcare providers.

“We are deeply concerned that their decertification would create unnecessary risk for our region – jeopardizing timely access to organ transplants and undermining support for donor families,” the letter says.

LifeCenter has said those circumstances and issues that come up while serving rural areas “disproportionately and negatively affect LifeCenter Northwest’s evaluation.”

‘A greater mission’

In 2025, 73 Montanans received transplants and another 211 donated organs. LifeCenter Northwest has also seen a 100% increase in lives saved over the last decade. Those interested in organ donation in Montana, can visit donatelifemt.org.

One of those recent recipients was Ware, who is thriving, he said. 

A highlight for him has been the ability to ski again — he hadn’t in nearly 20 years prior to the operation because of his lungs. He said that after he woke up from his surgery, it was about his third breath when he realized everything had changed.

“I was surprised at how well I could breathe.” Ware said. “It’s such an incredible amount of gratitude that one has when one’s suffocating, just trying to survive that suffocation for so many years, and then one can breathe, and it’s like a whole new life.

Ware has operated Air Therapy Aviation, an organization that offers powered glider flights with the intention of inspiring people through flight. Ware has also been a licensed massage therapist for 40 years and at one point also competed in flying competitions.

“Your life has a greater mission after surviving something like that,” Ware said.