Overhaul of U.S. Organ Transplant System Proposed

Asingle nonprofit has what amounts to a monopoly over all organ transplants performed in the United States, but the federal government said that it plans to change that.

In 2022, a record 42,887 organ transplants were performed. Yet nearly 104,000 people remain on waiting lists for organs. About 22 people die each day while waiting, even as organs are discarded, damaged while being delivered or not collected, according to a new story published by the Washington Post.

The Health Resources and Services Administration (HRSA), which has contracted with the United Network for Organ Sharing (UNOS) to run the Organ Procurement and Transplantation Network for 37 years, announced in March it will invite organizations to bid for contracts for different parts of the transplant system’s functions.

“Every day, patients and families across the United States rely on the Organ Procurement and Transplantation Network [OPTN] to save the lives of their loved ones who experience organ failure,” HRSA Administrator Carole Johnson said in a news release announcing the change. “At HRSA, our stewardship and oversight of this vital work is a top priority. That is why we are taking action to both bring greater transparency to the system and to reform and modernize the OPTN.” plant center, Badran sees only a part of the donation process, typically in the ICU setting.

“Donation happens after brain death or after circulatory death,” he said. “That’s for organs. After the death, it’s tissue and eye donation. Unfortunately, when the time comes and the patient is extremely sick and on life support and the family or the patient decides that they want to withdraw life support, that’s when the brain or circulatory death happens.”

New York requires two physicians to certify brain death and meet extensive criteria for physicians to declare death. At that point, the hospital contacts FLDRN as required by law to make them aware of the brain death or imminent removal of life support so that FLDRN can check if the patient is a registered donor.

“We have no knowledge of that,” Badran said. “We have no access to that information.”

FLDRN representatives speak with the family about consent and seek a match to any organs that may be usable.

Some people resist signing up for organ donation as they assume that their family members would want to make that decision. Ryan said that selecting registration in advance can provide comfort to family members who do not have to make that decision. It can also help them feel that their loved one’s loss can at least benefit someone else.

“Is that something you’d want your family to decide at that worst possible moment?” Ryan said. “Make an informed decision if you want to give the gift of life and document that. That’s alleviating the responsibility from your family.”

Some people assume that their body is too old, ill or unusual to help others. However, Ryan said that no medical information is gathered upon registration.

“At the time of someone’s death, that’s when decisions are made about what can be donated,” she said. “Don’t rule yourself out. There’s no need to play doctor and decide if you’re led a healthy enough lifestyle. By ruling yourself out, you’re possibly ruling yourself out of saving

Among the plan’s many changes are steps to improve the technologies used by surgeons and transplant coordinators.

Network structure would also change, including adding a strong, independent board of directors. A new public dashboard should also make the donation and receipt process more transparent.

UNOS said in a statement it “supports HRSA’s plan to introduce additional reforms into the nation’s organ donation and transplantation system, and welcomed a competitive bidding process.”

“We believe we have the experi ence and expertise required to best serve the nation’s patients and to help implement HRSA’s proposed initiatives,” the statement said.

But the White House’s U.S. Digi tal Service called UNOS’s technolog ical system archaic in a confidential 2021 assessment for HRSA. It also recommended breaking up UNOS’s monopoly over that technology, the Post reported.

“UNOS has allowed the organ donation system to become mismanaged, unsafe and self-enrich- someone’s life.”

Ryan said that many people assume that religion forbids organ donation. Most major world religions support organ and tissue donation, viewing it “as the most generous last act anyone could do.”

She added that any religious, cultural or familial beliefs should be discussed before deciding about organ donation.

“We don’t claim to be experts in knowing every culture and scenario,” Ryan said. “It’s such a personal decision. Have that conversation with your family and faith leader and a trusted healthcare professional. Say, ‘I’m not sure about this; can I talk this through with you?’ If you decide you don’t want to be a donor, tell your family. That’s important for your family to know so they’re not struggling with this decision.”

According to Health Resources & Services Administration, the most common transplants nationwide in 2021 were kidney (24,670, with 90,483 still waiting); liver (9,236, with 11,891 still waiting); heart (3,817, with 3,502 still waiting); lung (2,524 with 1,051 still waiting) and other (1,108, with 290 still waiting).

The “other” category includes skin, face, hands and abdominal wall. Some things such as a kidney, bone marrow and part of the liver may be donated by living donors. Upstate University Hospital in Syracuse represents the only transplant programs for kidney or pancreas transplants in Upstate New York.

The most common transplants in 2021 in NYS, according to Finger Lakes Donor Recovery Network ing,” Greg Segal, founder and CEO of Organize, a nonprofit patient advocacy group, told the Post. “Today’s announcement that HHS will break up UNOS’s monopoly, and bring in competent and transparent new contractors, is a transformative and unequivocal win for patients.”

UNOS oversees a transplantation network that includes about 250 hospitals that perform transplants. Also in the network are 56 government-chartered nonprofits that collect organs and labs that test organ compatibility.