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US modernizes organ transplant protocols in effort to improve efficiency, transparency

by John R. Fischer, Senior Reporter | March 27, 2023
To reduce waiting times and associated deaths, the Health Resources and Services Administration (HRSA) has announced it will boost the number of eligible management competitors for the Organ Procurement and Transplantation Network, and integrate more transparency and accountability into its processes.

Started in 1984, the OPTN is the first computerized system to match sick patients with the organs they need. Critics say the OPTN's current contract holder, United Network for Organ Sharing's poor management has led to a waiting list of more than 100,000 people, of which about 6,000 die each year, according to CNN.

Following a nearly three year investigation, the Senate Finance Committee revealed in August that failures in the OPTN led to 70 deaths and more than 1,100 complaints between 2010 and 2020, including testing for blood types and diseases, and errors in retrieval that rendered donations useless. It also said OPTN was still abiding by decades-old rules that limit appropriation and contracts for organ transplants.

To address these issues, HRSA will develop a new data sharing dashboard on individual transplant centers, as well as organ retrieval, waitlists, transplants and demographics. Additionally, President Joe Biden’s Fiscal Year 2024 Budget proposal calls for a $36 million increase for OPTN funding, bringing the total to $67 million, along with a request to Congress to remove the appropriations cap to expand eligible organizations that can compete for contracts.

“This iterative plan will specifically focus on five key areas: technology, data transparency, governance, operations, and quality improvement and innovation, said HRSA in a statement.

UNOS, which was the only bidder at the time, won OPTN's management contract in 1986 and has retained its grip through seven bidding rounds. It oversees nearly 400 members, including 252 transplant centers and 57 regional organizations, known as organ procurement organizations (OPOs), each with a defined geographic service area.

In its report, which was based on over 100,000 UNOS documents, the Senate Finance Committee found that under UNOS' management, organs were abandoned at airports or never picked up, and that some couriers missed their flights, leading to body parts being discarded.

Failure to test donated parts led 249 transplant recipients between 2008 and 2015 to develop diseases, with more than a quarter dying. In some cases, the transplants had to be removed.

Transplant professionals described the complaint process as a "black hole," telling the committee that UNOS often failed to address their concerns. In one instance, a patient was told he would likely die within three years after an Ohio OPO gave him a heart transplant from a donor who died of a malignant brain tumor. UNOS did not take any disciplinary action.

“It’s reasonable to assume that many more errors are going unreported. Why? Because filing official complaints with UNOS appears to accomplish zero productive oversight or reform,” said the committee in its report, calling the OPTN “outdated, mismanaged and insecure”.

In a statement, UNOS said a “competitive and opening bidding process” would help save as many lives “as equitably as possible.”

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