Poor oversight and multiple system failings are blamed for thousands of avoidable deaths.


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An estimated 17 Americans die each day waiting for organs, but a two-year investigation by the Senate Finance Committee has concluded that some of these patients could have been saved if organizations responsible for procuring and transporting donated organs in the United States functioned competently.

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In announcing the Senate committee findings, Chairman Ron Wyden (D-OR) last August charged the United Network for Organ Sharing (UNOS) with "gross mismanagement" of the nation's Organ Procurement and Transplantation Network, adding that "Americans are dying needlessly because UNOS and many of the transplant organizations it oversees are failing and seem uninterested in improving."


UNOS has nearly 400 member organizations, including 252 transplant centers and 57 regional organ procurement organizations (OPOs), which are responsible for obtaining and transporting organs within a defined geographical area. In testimony before the committee, two nurse OPO managers described system failings, including an outdated information technology system that requires onerous manual data entry, leading to errors and organ donor-recipient mismatches; lack of secure transportation for organs, resulting in lost or damaged organs or delayed delivery; lack of organizational transparency and motivation at UNOS to address complaints brought by OPOs, health care professionals, and consumers; and lack of accountability at poor performing OPOs. According to the committee report, regulatory changes and better OPO oversight could result in 28,000 more transplants each year.


The committee also cited reports by the National Academies of Sciences, Engineering, and Medicine and the U.S. Digital Service-both noted similar deficiencies and likewise recommended improvements in accountability as well as technology to support timely organ transfers, reduce allocation inequities, and foster organizational transparency.


None of these government and professional groups, including the Senate Finance Committee, can compel such improvements, since UNOS is a private, nonprofit organization that since 1986 has worked under a contract with the Department of Health and Human Services to run the national organ sharing system. According to UNOS data for 2022, there were 28,178 organ transplants between January and August, and as of September 20 a total of 105,859 people were awaiting transplants.


"Is there room for improvement in the system? A resounding yes," said Judith Hambleton, chief transplant coordinator for the Kidney and Pancreas Transplant Program at New York-Presbyterian/Weill Cornell Medical Center in New York City. But she added that she has not experienced the level of disfunction described in the Senate committee's report, telling AJN that in the transplant program at her hospital receiving damaged organs was a rare event. She endorsed the recommendations for greater operational transparency but noted that change in the UNOS system typically comes slowly, citing her experience on a kidney transplant committee where "it took more than a decade to change a policy."


Nevertheless, Hambleton urged nurses-the primary coordinators of organ transplants-to help improve the system by volunteering for such committee work. Documents concerning the Senate Finance Committee hearing, including statements from committee members and witnesses, are available at http://www.finance.senate.gov/hearings/a-system-in-need-of-repair-addressing-org.-Maureen Shawn Kennedy, MA, RN, FAAN