A proposed overhaul of the system that governs how human organs are procured, transported and transplanted in the United States could save many lives — if the Biden administration succeeds in breaking up the monopoly of the network that currently runs it.
A big part of the problem is that monopolies run the organ procurement system. Across the country, 56 “organ procurement organizations” have exclusive control over collecting organs in their respective regions. On the national level, the United Network for Organ Sharing (UNOS), a quasi-governmental agency, is supposed to oversee these regional organ procurers and run the logistical operation that matches organs with doctors, hospitals, labs and, ultimately, patients. Yet UNOS, too, is effectively a monopoly, having held the contract for running the system since it was created nearly 40 years ago.
With no competition, performance suffers. Independent reviews have found big problems, particularly in the technology UNOS uses to get organs from organ procurement organizations to the right patients at the right transplant centers, which critics complain still relies excessively on manual data entry. The system is prone to crashing, as it did for 40 minutes in February. This sort of failure could render unhealthy a freshly procured organ if it meant a delay in transporting it.
Skip to end of carousel
End of carousel- D.C. Council reverses itself on school resource officers. Good.
- Virginia makes a mistake by pulling out of an election fraud detection group.
- Vietnam sentences another democracy activist.
- Biden has a new border plan.
The D.C. Council voted on Tuesday to stop pulling police officers out of schools, a big win for student safety. Parents and principals overwhelmingly support keeping school resource officers around because they help de-escalate violent situations. D.C. joins a growing number of jurisdictions, from Montgomery County, Md., to Denver, in reversing course after withdrawing officers from school grounds following George Floyd’s murder. Read our recent editorial on why D.C. needs SROs.
Gov. Glenn Youngkin (R) just withdrew Virginia from a data-sharing consortium, ERIC, that made the commonwealth’s elections more secure, following Republicans in seven other states in falling prey to disinformation peddled by election deniers. Former GOP governor Robert F. McDonnell made Virginia a founding member of ERIC in 2012, and until recently conservatives touted the group as a tool to combat voter fraud. D.C. and Maryland plan to remain. Read our recent editorial on ERIC.
In Vietnam, a one-party state, democracy activist Tran Van Bang was sentenced on Friday to eight years in prison and three years probation for writing 39 Facebook posts. The court claimed he had defamed the state in his writings, according to Radio Free Asia. In the past six years, at least 60 bloggers and activists have been sentenced to between 4 and 15 years in prison under the law, Human Rights Watch found. Read more of the Editorial Board’s coverage on autocracy and Vietnam.
The Department of Homeland Security has provided details of a plan to prevent a migrant surge along the southern border. The administration would presumptively deny asylum to migrants who failed to seek it in a third country en route — unless they face “an extreme and imminent threat” of rape, kidnapping, torture or murder. Critics allege that this is akin to an illegal Trump-era policy. In fact, President Biden is acting lawfully in response to what was fast becoming an unmanageable flow at the border. Read our most recent editorial on the U.S. asylum system.
1/5
Nationally, more than one-fifth of recovered kidneys are not transplanted into needy people, a rate far worse than in peer European countries. There have been preventable — and deadly — snafus. A Senate Finance Committee investigation attributed 70 deaths and 249 illnesses to mistakes in organ screening before transplantation. A well-meaning reform meant to get organs transplanted into the sickest patients first appears to have led to a rise in the number of wasted livers, according to a new Post analysis.
Organ transplant system officials are “15 times more likely to lose or damage an organ in transit as an airline is to lose or damage your luggage,” Sen. Elizabeth Warren (D-Mass.) said in a hearing last year. Sen. Charles E. Grassley (R-Iowa) noted accusations that the system is rife with “fraud, waste and abuse, criminality, deadly patient safety issues, and failure to recover organs.”
UNOS’s contract with the federal government is up for renewal this year, and Biden administration officials proposed Wednesday some major reforms. One reason UNOS has typically encountered little competition for the contract to run the organ transplant system is that there are few entities that can operate a logistics network and perform all of UNOS’s other tasks. So, federal officials want to break UNOS’s functions into separate contracts, attracting companies to bid for the opportunity to operate specific parts of the system. This could be particularly helpful if it induced companies that specialize in complex logistics to seek the contract to improve the organ transplant system’s IT operations; if organ logistics were operated as efficiently as FedEx package delivery, fewer may be lost.
Biden administration officials say they have the legal authority they need to proceed. But Congress should provide any funds that might be required, particularly to make the new contracts more attractive to outside companies. Lawmakers should also review the statutes governing the organ transplant system, ensuring that the administrations have all necessary powers.
There are other things that should be done as well to improve the system. Even a more efficient logistical operation cannot maximize the number of organs collected. That is why organ procurement officials should explore new avenues to persuade more deceased people’s families to allow organ donations. They should also promote the use of organs from less-than-ideal candidates, such as older people or those who have certain infections. There is reticence among some in the United States to accept such organs — but an imperfect liver is better than none for those on the waiting list. Once organs are removed from the body, it is vital that they move to their new hosts quickly, which requires better coordination among surgeons and hospitals so they are on call to operate.
U.S. officials should ensure that the organizations they put in charge of these efforts are up to the task. That will be much easier if the Biden administration stays on course.