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Enable OPOs to merge or share services to boost their ability to serve hospitals and patients


Automate real-time donor referral

Establish better metrics

Get the right organ to the right patient

Remove disincentives

Enable OPOs to merge or share services

Save even more lives

The U.S. has the highest performing donation and transplant system in the world. But as good as it is, it needs to get even better to support the more than 100,000 patients on the waiting list. Based on the input of experts in our field, UNOS is proposing a five-part package of reforms to drive improvements to save even more lives.


​For nearly a decade, the number of organ donations and transplants in the U.S. has grown year over year, making our system the best in the world. The increase in donations and transplants has been driven by a number of factors, most importantly expanding the view of who is a potential donor and increasing the use of organs after circulatory death, as opposed to brain death, as well as organs from older donors. But the use of these strategies continues to vary greatly across regions of the country. More can be done to improve performance by OPOs and transplant programs so that organs that could save a life do not go unused. With more than 100,000 people on the organ donation waitlist, the system as a whole must continue to improve.


Provide regulatory mechanisms for OPOs to more easily merge, or pool, services to ensure continuous improvement, uninterrupted services, and equitable access to transplants across the nation.


CMS should create an expedited process for reviewing and approving a change in ownership for currently certified OPOs. CMS should also remove barriers to sharing resources. Additionally, it should provide incentives for OPOs to merge by extending an OPO’s certification cycle if its performance in the newly merged service area of a formerly lower performing OPO improves by a certain percentage in the first two years after enactment of the new regulation.

Originally published on Sept. 15, 2020; updated Dec. 5, 2020

1 million transplants

The U.S. surpassed 1 million transplants in 2022

The gifts of generous donors and their courageous families made several lifesaving transplant records possible.


Insights from UNOS leaders on key issues in transplant today

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Benefits of OPOs merging or sharing services

  • Prevent disruptions to transplant services.
  • Reduce business inefficiencies and strengthen existing resources and services.
  • Support OPOs in need of assistance and improve performance of the system overall.


Overview of the 5 ways collaborative reform package

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