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U.S. plans major revamp of troubled organ transplant system

Seventeen people die every day waiting for organ transplants in the U.S.
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The federal government Wednesday outlined a plan to revamp the nation's organ transplant system, which has been plagued by problems, including damaged or discarded organs and long wait times.

Around 104,000 people in the United States are on the waiting list for an organ transplant, according to the Health Resources and Services Administration, an agency within the Department of Health and Human Services. Seventeen people die each day waiting for an organ transplant.

The current system, experts say, is ineffective and usually benefits affluent white people who have the means to travel where organs are available.

"There are multiple problems that need to be addressed," said Dr. Stuart Knechtle, a general surgeon at the Duke University School of Medicine in Durham, North Carolina. “It’s clear that different groups of people by race and also by geographic location are served differently."

People involved in the system have been trying to make improvements for over a decade, Dr. David Mulligan, a transplant surgeon and immunologist in the Department of Surgery at Yale School of Medicine in New Haven, Connecticut, said in an interview.

"We've got to be able to get organs from donors to recipients in a more fluid, efficient way," he said.

The plan — outlined by HRSA in a release — would nearly double the amount of funding the government agency receives from the U.S. to $67 million in the fiscal year 2024 to "modernize" the nation's transplant system.

The current system is outdated, based on a model from the 1980s, Knechtle said. A new program would provide patients with more timely information, empowering them to take more control over the transplant journey, he said. It would also help address equity issues, where people who should be referred for a transplant are overlooked or given access to care too late.

The U.S. government would also siphon away some of the responsibilities performed by the United Network for Organ Sharing, more commonly referred to as UNOS, to other outside organizations.

UNOS, a nonprofit organization based in Richmond, Virginia, has been the sole manager of the nation’s organ transplant system since 1986, when the federal government awarded the group a contract. The group has essentially operated as a monopoly, overseeing the system that gets donated organs to seriously ill patients.

The group has been blamed by U.S. lawmakers and other outside groups for not adequately managing the nation's transplant and organ procurement centers, which has resulted in damaged organs and delays that led to unsuccessful transplants, Mulligan said, adding that he thinks some of the critiques are unfair. Mulligan is a former president of UNOS.

The idea of splitting up responsibility, Mulligan said, is to have more collaboration, which could make the system more efficient and save more lives.

UNOS did not immediately reply to a request for comment.

The government's plan would also create an independent board of directors as well as produce an online dashboard that would give the public more information, including on organ retrieval, waitlist outcomes and demographic data on recipients.

The moves would create "transparency and accountability in the system," Carole Johnson, the administrator for HRSA, said in a statement.

“Every day, patients and families across the United States rely on the Organ Procurement and Transplantation Network to save the lives of their loved ones who experience organ failure,” Johnson said.

There's no set timeframe for when the changes will be implemented, Johnson suggested in an interview, noting the agency is approaching the revamp very "thoughtfully."

Knechtle said he was "eager" for changes.

"I think there's been a great deal of criticism of the system. And we agree with those criticisms," he said.

In January, UNOS proposed its own series of reforms for improving the organ transplant system, including creating new tools that would help patients better navigate the donation and transplant process.

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