Last year, the United States performed more than 41,000 organ transplants. The majority of these were made possible by donations from the deceased. The report of Friday’s National Academies of Sciences, Engineering and Medicine highlights the problems that keep more lives from being saved.
There are more than 106,000 people on the national waiting list for a donor organ transplant. At least 17 others die each day while they wait. The report stated that many more people who could benefit from a transplant are not on the waiting lists, especially those of color. Geography is one of the many challenges. It can make a big difference in how long it takes for someone to match and whether organs that could be used are found when they die. Too often, organs that are not perfect go unutilized.
The panel was chaired by Dr. Kenneth Kizer who is a respected expert in quality health care and a noted transplant advocate. There are many things that can be done to improve the system’s effectiveness for more people.
The panel’s top conclusion:
The Department of Health and Human Services should establish national performance goals, including at least 50,000 transplants per year by 2026. This is the department that regulates the transplant system. Although transplants have been increasing steadily for many years, it would be necessary to accelerate the process.
Hospitals should reduce organ waste and talk to patients about the possibility of a less than perfect offer. Kizer, for example, stated that nearly 25% of kidneys donated were not used last year. The panel hopes to reduce this number to 5% by 2026. Study after study found that surgeons in France often use lower-quality kidneys from older donors with comparable success to their American counterparts. However, not all hospitals are willing to accept such organs. Kizer stated that too many patients are not told if their doctor declined a chance.
He said, “It’s too simple for transplant centers to reject usable organs.”
HHS should be held accountable by Congress for reducing disparities within the same timeframe. Black Americans are three times as likely to develop kidney disease than whites, but they are far less likely to be referred to a transplant clinic. They are more likely to wait for a deceased donor organ and less likely find a living one.
There were many steps that could be taken to reduce these disparities, but the panel recommends the following: The federal government should begin its regulatory oversight as soon as patients are diagnosed with organ disease — not waiting for them to get on the transplant waiting lists.
Although the Academies report only contains recommendations, Congress requested that the panel examine the transplant system.
The Biden administration stated Friday that it will consider the recommendations and begin a previously scheduled renewal of the federal contract for the operation of the transplant system.
“HHS intends use the tools we have to increase oversight and accountability in relation to the contractor who receives the award,” a spokesperson for HHS’ Health Resources and Services Administration stated in a statement.
Some changes were already underway. The United Network for Organ Sharing now manages the transplant system. They have updated policies to reduce disparities. This includes changing how organs are distributed so that a patient’s ZIP Code matters less. These changes were sometimes stalled by feuding transplant centers.
Medicare, under the Trump Administration, set new standards for improving the performance of the various groups in the country responsible for collecting organs and transporting them to the appropriate transplant center.
UNOS released a statement Friday confirming that some of the recommendations in the report are valid steps it is already taking to improve organ distribution equity. It also welcomed calls for systemic changes to “improve access to care” and to reduce the waitlist.
