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UNOS plan reimagines governance of U.S. transplant system to best serve patients 

UNOS plan reimagines governance of U.S. transplant system to best serve patients 

Roadmap outlines how to create an independent OPTN Board in a move endorsed by Congress

United Network for Organ Sharing (UNOS) officially submitted a plan to the Health Resources and Services Administration (HRSA) that would establish a new governance structure for the OPTN in order to strengthen public trust and oversight and accountability.

UNOS is the mission-driven, non-profit organization that serves as the nation’s organ donation and transplant system—the Organ Procurement and Transplantation Network (OPTN)—under contract with and overseen by HRSA.

The OPTN Independence Plan, which HRSA requested through a contract modification in May 2023, outlines how best to establish an OPTN Board that is legally independent from the OPTN contractor’s board, with no overlap in membership and with distinct obligations. Creating an independent OPTN Board would require the incorporation of the OPTN as an independent, nonprofit organization.

The plan represents the culmination of a multi-year effort. UNOS first requested HRSA engagement in May 2021 to create an independent OPTN Board. In January 2023, UNOS sent a follow-up letter to HRSA Administrator Carole Johnson, advocating for a contract modification that would allow UNOS to submit a roadmap detailing concrete steps to advance board independence.

“The roadmap that we submitted is a critical step forward for the nation’s organ donation and transplant system and the patients and families who depend on it,” said UNOS CEO Maureen McBride, Ph.D. “Transplant patients will be best served if the OPTN and its Board are given greater independence. Our plan increases accountability, transparency and good governance, which will lead to greater public trust in the national system.”

Since the formation of the OPTN, the OPTN and UNOS have used a unitary board approach, where the UNOS Board also serves as the OPTN Board. This has been done in compliance with the National Organ Transplant Act (NOTA), the OPTN Final Rule and the current OPTN contract held by UNOS. Efforts to reform and improve the national system, however, require a collaborative reimagining of this structure.

UNOS’ plan will accomplish several critical goals of UNOS, HRSA, Congress and federal partners. It will provide the continuity of services on which patients rely while ensuring the OPTN’s independence from any current or future OPTN contractors.

“The OPTN Independence Plan also promotes competition for the upcoming OPTN contract, eliminating any potential or perceived conflict of interest,” UNOS Board President Dianne LaPointe Rudow, ANP-BC, DNP, FAAN, said.

Creating a legally independent OPTN corporation is a key pillar of UNOS’ Action Agenda and was endorsed by the Senate Finance Committee in its August 2022 report. The proposed plan is subject to HRSA approval.

“We are committed to working with HRSA to ensure the successful and timely implementation of any OPTN governance restructuring plan by March 30, 2024,” McBride continued. “It is imperative that we pursue reforms as a unified community, and I am proud of the cooperation at all levels that has resulted in this plan.”

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