You wouldn’t ship your family pet in the cargo space of a commercial airline with bags and packages, so why does the U.S. ship lifesaving, donated organs for transplant in cargo?

Organs cannot move through airport security without a ticketed passenger, so when an organ is unaccompanied, it is relegated to cargo. UNOS is trying to change this outdated policy.

Before the attacks on September 11, 2001, donor organs were transported in the cabin of commercial flights under the watchful eye of the flight crew before being delivered directly to a transplant professional at the gate.

The attacks prompted protocol changes at airports, and since then, organs have been transported with cargo. Today’s rules prevent donation and transplant professionals from accompanying organs through security to and from an aircraft, so precious organs are moved across the country like other cargo.

Transporting organs as cargo is a fundamentally bad practice.

It requires more logistical planning and does not lend itself to the time-sensitive nature of organ transplantation, where every second counts. Donor organs must be transplanted within a specific and limited period of time to patients in need, 365 days a year.

Organs transported by cargo must arrive at the airport 60 to 120 minutes before flight departure. If an organ arrives after the cut-off time, it cannot be transported on that flight. Also, airline cargo offices have highly variable hours, and if an organ arrives at its destination on time but the cargo office is closed, it cannot be collected by a courier.

Logistical delays heighten the risk that a viable organ cannot be transplanted. According to the nation’s Organ Procurement and Transplantation Network, 2.5% of unused organs are due to transportation issues. 

For all of these reasons, UNOS is working to ensure organs can be transported in the cabin of airplanes.

As a result of UNOS-led advocacy, Congress has demanded that the U.S. Department of Transportation and the Federal Aviation Administration convene a working group to fix this issue. That group is expected to make recommendations by the summer of 2025.

Here’s the bottom line

Life-saving organs should not be relegated to airplane cargo bays, where they are more prone to be lost or delayed because of cargo staffing limitations. Transporting life-saving organs in airplane cabins ensures that they will be handled with care and avoid damage, delay or loss, which will help more people get the transplant they need. 

UNOS looks forward to the DOT’s and FAA’s recommendations to once again transport organs in the most efficient and responsible manner: in the aircraft cabin.  While it’s the responsibility of organ procurement organizations – not UNOS – to transport organs, UNOS is committed to making this change to improve patient outcomes and ensure all organs can be transported and transplanted quickly and safely.

We can track the shoes we ordered from Amazon, and we can follow along as our pizza is baked and delivered by Domino’s. So why shouldn’t we be able to track organs that will save the life of someone in need of a transplant?

Every donated organ is a gift, and should not be lost, delayed in transit or damaged. That’s why UNOS is taking the lead to push for the federal government to mandate the use of physical tracking for unaccompanied deceased donor organs. This is the best way to ensure each gift of life reaches its destination.

Incredibly, there is currently no national tracking system for donor organs. That means organ procurement organizations (OPOs), transplant hospitals and the federal government lack consistent insight into the status of organs during transit to a patient waiting for a transplant.

UNOS has taken action, as a private entity, in developing and launching its own organ tracking solution, currently in use by 12 OPOs across the country.  UNOS’ organ trackers have successfully tracked more than 20,000 organ shipments.

But UNOS’ work is not enough. The federal government must require, develop and enact a solution for national systemwide organ tracking.

A national, centralized and mandatory tracking system would give key organ transplant stakeholders maximum visibility into the transportation of life-saving organs. It would also enable thorough investigations of lost or delayed organs, which is critical to implementing systemwide improvements.

This concept has been discussed for several years but requires federal action. A key priority in 2025 for the new Secretary of the U.S. Department of Health and Human Services should be to direct the Health Resources and Services Administration to establish a federal tracking system that uses physical tracking technology as part of the OPTN modernization efforts. More lives can and will be saved through this change.

The Medicare Increasing Organ Transplant Access Model 

Did you know that a leading cause of death in the United States is chronic kidney disease, which affects almost 15% of adults and can lead to kidney failure? Dialysis is a lifesaving treatment for kidney failure, but requires the patient to be hooked to a dialysis machine for hours at a time, often for several days each week.

At any given time, nearly 90,000 people in the United States are waiting for a kidney transplant, and 13 people die every day waiting for a kidney.

This cannot continue. That’s why UNOS supports public policy changes to make more kidney transplants possible for Medicare patients.

In late 2024, the Centers for Medicare & Medicaid Services (CMS) released its proposal to help, called the Increasing Organ Transplant Access (IOTA) Model, which will study ways to increase the number of kidney transplants and improve the quality of care for kidney patients. The model will test and determine how financial incentives – and disincentives – for transplant hospitals impact the number of transplants, care quality and equity.

One of the key patient-focused aspects of the IOTA model, advocated for by UNOS, is the requirement for transplant centers to publish the criteria they use to determine whether to add a patient to the kidney transplant waitlist. UNOS believes this is critical to improving transparency for the process and ensuring that the system is patient-centric.

The IOTA model will go into effect on July 1, 2025, and will be in place for six years. UNOS is working with the kidney donation and transplant community to develop products and tools to help transplant hospitals track the IOTA metrics.

Although it is yet to be seen how the change from the Biden to the Trump administration could change the IOTA model or the approach to achieving the goal to increase transplants, UNOS will continue working with the federal government and the organ donation and transplant community to increase transplants and help more people get the lifesaving transplants they need.

Organ donation is a gift of life. It’s also a time-sensitive gift; when an organ becomes available, time is of the essence to ensure it’s able to be transplanted while still viable.

A nationwide nursing shortage, combined with the fact that time is so precious to the organ transplantation process, means that it’s critical that communication is expedited with local organ procurement organizations (OPOs) to make the best use of every gift of life. And with hospitals using electronic health records (EHR), there is an opportunity to improve the efficiency of the organ referral process – the notification process that a potential donor organ meeting predetermined clinical criteria may be available for transplant. In fact, there are pilot studies underway with software that will help overburdened hospital staff save precious minutes and identify more potential deceased organ donors.

UNOS supports mandated automated deceased organ donor referrals, as widespread use could significantly expedite the process of identifying potential organ donors. This will ultimately increase the number of patients who receive lifesaving transplants.

So how does it work?

1Automated electronic deceased donor referrals are used by hospitals to instantly alert OPOs of patients who are candidates for deceased organ donation.

2The technology uses hospital EHR systems to flag patients who are showing signs of imminent death, and then sends an automatic message to the collaborating OPO.

3This referral includes enough information to inform the OPO that they may begin evaluating the patient’s suitability for deceased organ donation. 

While there are successful pilot programs, the referral process is still typically performed manually by hospital staff relying on a nurse to make a phone call. Automating the referral process with software would lift the burden of reporting from busy hospital staff amid the nationwide nursing shortage, reduce the risk of human error and ensure every potential donor is referred. 

Widespread use of automated electronic deceased donor referral could increase donor referrals and therefore organ donors, which would help reduce the number of Americans waiting for a lifesaving organ transplant. 

UNOS calls on Congress to require automated deceased donor referral.