The U.S. Organ Donation & Transplantation System
UNOS advocates for reform and modernizationFor nearly four decades, the United Network for Organ Sharing (UNOS) has been the central hub of a complex and interconnected network of patients, hospitals, insurance companies and the federal government comprising the nation’s organ donation and transplantation system. A federal contractor, UNOS has played the most essential role in establishing the U.S. as the global leader in organ donations and transplantations. For 14 consecutive years, the number of life-saving organ transplants has increased under the oversight of UNOS, culminating in more than 46,000 successful organ transplants in 2023 – a record that is expected to be eclipsed by the end of 2024.
The problem
Too many terminal patients aren’t receiving life-saving organs in time. Today, more than 100,000 patients are awaiting transplants. To make matters worse, each year, more than 28,000 donated organs go unused because of inherent inefficiencies in the system. Every day, an average of 17 people die in the United States awaiting organ transplants. This unacceptably high number isn’t the fault of any single entity comprising the U.S. organ donation and transplantation system; rather, it’s the result of systemic inefficiencies that must be addressed.
UNOS has been a driving force in addressing many of these inefficiencies, primarily through massive investments in technology. But the most significant barriers standing in the way of a more efficient system can only be addressed through a combination of regulatory and statutory policy changes, coupled with cooperation from hospitals, organ procurement organizations, transplant centers, and private health insurers.
UNOS has been at the forefront of identifying these obstacles and proposing solutions – solutions that cannot be undertaken by UNOS alone.
The Solutions: UNOS advocates for reform and modernization
UNOS is uniquely positioned to help Congress modernize the organ donation and transplantation system through key patient-centric reforms. No other entity than UNOS has more visibility into the complex landscape of organ transplantation, where life-and-death outcomes depend on lightning-fast information sharing, medical knowhow and efficient logistics.
Under its new leadership, UNOS has embraced urgency and resolve to effect change within the organ donation and transplantation system. Now, UNOS is calling on Congress to adopt long-overdue policy changes that could dramatically reduce the number of patients who die every day awaiting organs.
Key reforms
Mandated automated donor referrals (ADR)
Successful organ transplants depend on information-sharing with organ procurement organizations (OPOs), regional non-profits that are responsible for recovering organs from deceased donors. This reporting is frequently undertaken manually, and by overworked hospital staff. Automated referrals would ensure OPOs are automatically alerted about a potential organ donation when a dying patient meets predetermined clinical criteria. Studies have found a 49 percent increase in donor referrals and a 333 percent increase in organ donors upon implementation of ADR.
Mandated in-cabin airline transportation for organs
Life-saving organs should always travel in-cabin, and they should never be relegated to airline cargo bays, where they are more prone to be lost or delayed because of cargo staffing limitations. According to government estimates, 2.5 percent of wasted organs were the result of transportation issues.
Mandated organ tracking for unaccompanied organs
Every organ is a potential life-saving gift, but currently there is no national tracking system for organs to prevent them from being lost, delayed in transit, or damaged. A national, centralized, system-wide tracking system would give key organ transplant stakeholders maximum, real-time visibility into the transportation of life-saving organs, while also enabling thorough investigations of lost organs, which is critical to implementing systemwide improvements.
Incentivizing transplant hospitals to transplant hard-to-place organs
The vast majority of organs that remain unused is the result of multiple hospitals declining to accept them because they determine the organ has minor anatomical defects or damage. Last year, more than 8,000 kidneys were discarded because they could not be paired in time with a hospital possessing requisite expertise in transplanting hard-to-place organs. Studies show that 62 percent of kidneys discarded in the U.S. would have been successfully transplanted in France. If crafted correctly, a policy change to Medicare would encourage more hospitals to develop the expertise needed to accept less-than-perfect organs, ultimately preventing nearly 4,000 avoidable deaths annually (11 of the 17 patients who die each day awaiting organ transplants).