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Actions to strengthen the U.S. organ donation and transplant system

Governance: Make the OPTN an organization independent of the OPTN contractor


Governance of the OPTN has been an area of ongoing attention. UNOS has requested HRSA engagement since May 2021 to create an independent OPTN board of directors distinct from the OPTN contractor’s board of directors.

At HRSA’s direction via an OPTN contract modification, UNOS submitted an in-depth OPTN Independence Plan to HRSA in July 2023. The plan outlines steps to create a legally independent OPTN organization, including an independent OPTN board of directors distinct from the OPTN contractor’s board of directors. UNOS is committed to working with HRSA to ensure the successful and timely implementation of any OPTN governance restructuring plan by March 31, 2024. The proposed plan is subject to HRSA approval.

UNOS will undertake/propose the following action


Recently, UNOS proposed an amendment to the existing OPTN contract to HRSA to accomplish a fully compliant restructuring with separate boards of directors by the end of the current OPTN contract, on Sept. 29, 2023, pending HRSA approval. Partnership with HRSA is essential to the successful development of any OPTN governance restructuring plan.1


Communication: timely communication is critical to ensuring good governance.

As a part of UNOS’ efforts to strengthen and improve governance, we will advocate for the addition of a provision to the future OPTN contract to empower the OPTN to communicate with patients and professionals expediently.

As a network of donation and transplant clinicians, professionals and patients, it is incumbent upon the OPTN to provide timely information related to emergent public health crises, patient safety concerns, time-sensitive policy changes and more. To effectively keep OPTN members and the public informed, such a contract modification would allow for more nimble and flexible communication with professionals and the public.

UNOS published the Action Agenda on Jan. 30, 2023, to reflect the needs of the broader donation and transplant community. As we progress on the actions and recommendations outlined, we will post updates here accordingly.

“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.”

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Maureen McBride, Ph.D.



1 “UNOS letter to HRSA Administrator to request review of proposed OPTN governance restructuring.”‐content/uploads/UNOSGR‐2023‐01‐10‐UNOS‐Letter‐to‐HRSA‐Admin‐Johnson.pdf. 10 Jan. 2023.

All stakeholders, including UNOS, share a common mission:

Get as many usable transplant organs as possible to patients who need them, fairly, equitably and efficiently.

All parts of the national system must be held accountable for making sure that this happens. The OPTN contractor must provide the highest level of service to patients and the greatest level of transparency to the public who has charged it with this lifesaving work.

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