According to Donate Life America, 17 people die every day in the United States waiting for an organ transplant. But people patiently waiting for a life-saving organ transplant may soon get good news. On September 22, President Biden signed the US Organ Procurement and Transplantation Network Act, a bipartisan bill to reform the nation’s organ transplant system.
“In the United States, we transplant kidneys, liver, heart, lungs, pancreas and intestines,” says University of Nebraska Medicine nephrologist Clifford Miles, MD. “There are more than 140,000 people on the transplant list, and kidneys are most needed, followed by livers. People who need a kidney transplant can survive on dialysis for years. In comparison, if someone’s liver is completely damaged, it is difficult to keep him alive without a transplant.
Most people who need a kidney will have to wait about three to five years on the national transplant waiting list. Of the 17 people who die every day in need of organ transplant, 12 are waiting for a kidney.
The bill aims to increase competition among contractors, obtain additional funding, and improve the Organ Procurement and Transplantation Network, or OPTN. White House press secretary Karine Jean-Pierre told reporters that the new law would break up the monopoly system of single private nonprofits on OPTN.
Dr. Miles says the OPTN coordinates and manages organ procurement, allocation and transplantation. Since 1987, the United Network for Organ Sharing, or UNOS, has been the sole entity managing OPTN through a contract with the Health Resources and Services Administration, or HRSA.
UNOS is a private non-profit organization that manages the organ transplant system under contract with the federal government. UNOS has been criticized over the years, and a Senate Finance Committee reported that a “broken system” led to long wait times for organ transplants, leading to deaths. According to the National Library of Medicine, white patients are more likely to be rated as “suitable candidates” for organ transplants than black patients.
“There is evidence that people of color and those of lower socioeconomic status are less likely to receive an organ transplant,” says Dr. Miles. “Some of the reforms are aimed at correcting inequities and inefficiencies in the process, from management of organ donors to procurement, as well as screening to transportation. Organs are rarely destroyed during transportation, but it has happened.”
Dr. Miles says part of the test is that one entity controls the entire OPTN contract, which made sense when the organ transplant system and the need for organs were small.
“The number of donors and patients requiring organ transplants has increased rapidly. “The system itself has evolved,” says Dr. Miles. “The most objective thing would be for HRSA to offer multiple contracts rather than one. There could be four or five contracts, depending on how it’s divided.”
Dr. Miles explains that splitting the contracts as well as modifying the organ allocation is a process that may take a few years. HRSA’s open bidding on new contracts aims to broaden eligibility criteria, remove unnecessary barriers, and promote transparency, accountability and oversight.
While organ donation from deceased individuals is quite common, living organ donation for kidneys and liver is also possible. This can dramatically reduce the time a person spends waiting for a transplant. The Nebraska Medicine transplant team has extensive experience in transplants with living donors and has had great success conducting large-scale living donor kidney transplant series.
