The United States counted its millionth organ transplant on Friday, a milestone that comes at a critical time for Americans still desperately waiting for that chance at survival.
It took decades from the first success – a kidney in 1954 – to transplant 1 million organs, and officials cannot reveal whether that last one was also a kidney or another organ. But advocates have launched a new campaign to speed up the next million transplants by encouraging more people to register as organ donors.
Yet the national transplant system is at a crossroads. More people than ever are getting new organs – a record 41,356 last year alone. At the same time, critics blast the system for its policies and outright mistakes that waste organs and cost lives.
Anger boiled over last month at a Senate committee hearing in which lawmakers accused the United Network for Organ Sharing, a nonprofit that holds a government contract to run the transplant system, tedious organ tracking and poor monitoring.
“It’s sitting on your hands while people are dying,” Sen. Elizabeth Warren, D-Massachusetts, told the organization’s chief executive as she and other senators suggested UNOS be replaced.
UNOS is continually taking steps to improve organ supply and equity and will only be satisfied when everyone who needs a transplant has one, CEO Brian Shepard responded.
Other experts say the fireworks are a distraction from work already underway.
“Everyone would like the system to be better,” said Renee Landers, a health law expert from the University of Suffolk who, as part of an independent scientific advisory panel to the government, co-wrote a change plan earlier this year.
This blueprint, from the National Academies of Sciences, Engineering and Medicine, sets a five-year deadline to improve every part of the complex transplant system – including groups that collect organs from deceased donors, centers for transplants that decide which to use, and the government agencies that regulate both.
“Focusing on just one aspect will actually not achieve” that goal, Landers said. “There are so many other pieces that need to fall into place.”
In the United States, more than 400,000 people are living with functioning transplant organs, UNOS said on Friday. For all the lives saved each year, more than 105,000 people are on the national list waiting for a new kidney, liver, heart or other organ, and about 17 a day die while waiting.
Too often, potentially usable organs are not retrieved from potential donors and too many hospitals are turning away less than perfect organs that could still provide a good outcome for the right patient, according to the National Academies report.
Kidneys are the most requested organ and almost a quarter of those donated last year were thrown away, refused by hospitals for various reasons.
A Senate Finance Committee investigation revealed additional issues, including failed tests that between 2008 and 2015 led to 249 transplant recipients developing diseases from donated organs, 70 of whom died. In other cases, organs shipped from one hospital to another were lost in transit or delayed so long that they were not usable.
Although these types of errors should never happen, they represent only a small fraction of the tens of thousands of transplants performed during this time.
Solutions to the most common problems – procuring more organs and ensuring they are used – are more difficult, but attempts are underway:
– Kidney transplants rose 16% last year – and 23% among black patients – attributed to a UNOS-ordered change in organ distribution that allows kidneys to be shipped to more patients patients further away rather than first being offered to hospitals near where they were donated.
–In July, UNOS told hospitals to stop using a certain formula for testing kidney function that may underestimate black patients’ need for transplants and make them wait longer than similarly white patients. sickness.
–Some “organ procurement organizations,” or OPOs, retrieve organs from deceased donors at much higher rates than others. Medicare finalized new rules this year that need to be improved or the worst performers could be closed in 2026.
—OPOs are reluctant to retrieve less-than-perfect organs that they know nearby hospitals won’t accept. Some hospitals can still refuse kidneys from donors over 70 or from diabetics, for example. But soon, kidney acceptance rates from transplant centers will be tracked as a new measure of quality.
To prepare, dozens of hospitals are using new computer filters to refuse even to receive offers they have no intention of accepting. Ignoring them could allow these offers to reach places like Yale University’s transplant center – known for its success with less-than-perfect kidneys – faster – before organs sit on ice too long to be usable.
“You can’t criticize OPOs for not salvaging organs if you don’t start holding transplant programs accountable for the decisions they make,” said kidney specialist Dr. Richard Formica, director of the Yale Transplant Medicine. “We need to find ways to get people to change their behaviors.”