US Organ Transplant System Threatens the Lives of Organ Recipients

The organ transplant system is run by the United Network for Organ Sharing (UNOS). The system has historically been criticized for its multiple shortcomings. More recently, the organ transplant system has been determined as the source of numerous infections in recipients. A recent meeting from the United States Senate Committee on Finance discussed the organizational failures of this system.

According to UNOS, approximately 105,922 people in the US need an organ transplant. As of June 2022, 10,286 donors allowed for 20,663 transplants to be performed.

While many transplants have been performed, this process is hardly equitable. “The reality is that the uninsured, underinsured, and the poor do not currently have an equal opportunity to fully realize the benefits of organ transplantation because they do not have equal access to costly and necessary post-transplant immunosuppressant medications stated researchers in the AMA Journal of Ethics.

Beyond the lack of equity, an article from the Washington Post states that errors in the organ transplant system between 2008 and 2015 have led to approximately 70 deaths and 249 diseases. Speakers at the meeting have cited oversites by UNOS in overseeing organ procurement organizations (OPOs).

Speakers at the meeting stated that, in the decade between 2010 and 2020, over 1,100 complaints were filed against UNOS. “The nature of those complaints runs the gamut. For example, in several cases, OPOs had failed to complete critical, mandatory tests for things like blood types, disease, and infection,” said Chairman Ron Wyden in his written testimony.

Many witnesses came forward and stated highlighted issues in the organ transplant system. Speakers included Brian Shepard (UNOS CEO), Diane Brockmeier, RN (President and CEO of Mid-America Transplant, Barry Friedman, RN (Executive Director of Adventist Health Transplant), Calvin Henry (transplant recipient and patient affairs committee representative), and Jayme Locke, MD, MPH (Director Division of Transplantation, Heersink School of Medicine, University of Alabama at Birmingham).

Many witness statements, such as the one from Diane Brockmeier, RN, who used to work for UNOS, criticize the organization for not upholding its mission.

“Transplantation was always supposed to be about the patient, but the system we operate now has almost a complete lack of ownership and responsibility, whether it is an OPO failing to show up at donor hospitals and engage families or UNOS failing at the most basic responsibilities of getting recovered organs matched and safely to the recipients at the other side. These are the government’s own contractors,” stated witness Jayme E. Locke, MD, MPH, in his written testimony.

The National Foundation for Transplants estimates that the cost of an organ transplant can range from $69,400 to $276,480, with a heart transplant being the most expensive. These numbers assume the patient has insurance that only requires them to pay 20% out of pocket. The estimated overall charges for a heart transplant are $1,382,4000.

In addition to transplant costs, many patients who have experienced errors in the system have experienced a greater financial burden in addressing these errors. Issues of price, quality, and equity make it abundantly clear that this system is flawed. Many physicians, patients, nonprofits, and government officials have called for an improved system.