Feds Propose Overhaul of U.S. Organ Transplant System

THURSDAY, March 23, 2023 (HealthDay News) — A single nonprofit has what amounts to a monopoly over all organ transplants performed in the United States, but the federal government said Wednesday that it plans to change that.

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 it will invite organizations to bid for contracts for different parts of the transplant system’s functions.

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.

HRSA Administrator Carole Johnson said she plans to ask Congress to change the law and raise the cap on what her agency can spend on contractors, but she added that she has legal authority to do so even if Congress does not respond favorably.

The challenge is that the 1984 National Organ Transplant Act established the network with UNOS as a “quasi-governmental agency,” even though it is a nonprofit. UNOS said in a statement Wednesday it “supports HRSA’s plan to introduce additional reforms into the nation’s organ donation and transplantation system, and welcomed a competitive bidding process. The statement added, “we believe we have the experience and expertise required to best serve the nation’s patients and to help implement HRSA’s proposed initiatives.”

But the White House U.S. Digital Service called the UNOS technological system archaic in a confidential 2021 assessment for HRSA. It also recommended breaking up the UNOS monopoly over that technology, The Washington Post reported.

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, The Post reported. The greatest need is for kidneys. And disparities exist, with White, affluent people more likely to receive the organs they need than poor and minority patients.

In 2020, 21.3 percent of procured kidneys were not transplanted and were later discarded, The Post reported, citing the Scientific Registry of Transplant Recipients. That data analysis operation is separate from UNOS. Other countries have lower discard rates, such as 9.1 percent in France between 2004 and 2014 and 10 to 12 percent in the United Kingdom.

The Washington Post Article