Biden Administration Launches Overhaul of Organ-Transplant System

The Biden administration on Wednesday announced initiatives aimed at transforming the U.S. organ-procurement system, adding more competition to improve transparency and accountability. 
The Health Resources and Services Administration said it would solicit multiple contracts for managing and improving the Organ Procurement and Transplantation Network, which was established by Congress in 1984 and manages the nation’s organ-transplant system under contract with the federal government. 
Soliciting multiple contracts could likely lead to breaking up the United Network for Organ Sharing, or UNOS, a nonprofit that administers the Organ Procurement and Transplantation Network. The news was first reported by the Washington Post
Pressure to overhaul the organ-procurement system has been growing. A 2022 report from the National Academies of Sciences, Engineering, and Medicine found that minority groups had inequitable access to transplant waiting lists and that there was significant nonuse of donated organs—approximately one in five kidneys from deceased donors aren’t used. 
In the U.S., more than 110,000 patients are on the national transplant wait list, and each day at least 17 die waiting for an organ transplant, the report said.
The overhaul of the nation’s system will modernize the technology system for the Organ Procurement and Transplantation Network. The agency is also aiming to provide more public data from transplant centers and organ procurement organizations on organ retrieval, wait list outcomes and transplants.
The initiatives also aim to further the independence of the board of directors who serve on the Organ Procurement and Transplant Network through awarding multiple contracts, according to the agency. 
Health and Human Services in 1986 awarded a contract to UNOS to manage the transplant system, and some patient advocacy groups have criticized the idea of UNOS having a monopoly. 
UNOS supports the plan for reforms and welcomes a competitive and open bidding process, said Anne Paschke, a spokeswoman for the organization. 
“We believe we have the experience and expertise required to best serve the nation’s patients and to help implement HRSA’s proposed initiatives,” she said in a statement. “Numerous components of HRSA’s plan also align with our new action agenda, which is a list of specific proposals we outlined earlier this year aimed at driving improvement across the system.”
Organ donation is managed by about 60 organ-procurement organizations that coordinate local efforts, with UNOS coordinating at the national level. UNOS was the subject of a bipartisan investigation by the Senate Finance Committee in 2022 that found errors in the procurement and transplant system. Between 2010 and 2020, more than 1,100 complaints were filed by patients and families, staff, transplant centers and others, according to a summary of the report given as remarks by Democratic Sen. Ron Wyden of Oregon.
Then-UNOS Chief Executive Officer Brian Shepard testified at the time that “we were surprised and disappointed by the Senate Committee on Finance’s misunderstanding of the role UNOS has been assigned by the government within the nation’s organ donation and transplant system.”
He said UNOS remains dedicated to working with Congress to improve the system.
Mr. Wyden called Wednesday’s announcement “a big victory for families across the country who have been fighting for a more effective organ procurement and transplantation system.”

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