US Senate Finance Committee calls out transplant procurement system for poor performance
Members of the U.S. Senate Committee on Finance grilled leaders of the United Network for Organ Sharing during a recent congressional hearing on poor management of the nation’s organ supply.
“Far too many Americans are dying needlessly because [United Network for Organ Sharing] UNOS and many of the transplant organizations it oversees are failing and seem uninterested in improving,” Senate Finance CommitteeChairU.S.Sen.RonWyden, D-Ore.,said in opening remarks at the hearing.
Wyden and others who testified, including transplant surgeons, patients and organ procurement organizations (OPOs), toldBrian Shepard,CEO for UNOS, that patient deaths have occurred because the organization uses antiquated computer systems for allocating organs via the national waitlist – which now contains the names of more than 100,000 patients – and allows organs to go to waste because of transportation problems.
“As OPOs, we are required to work with UNOS technology – DonorNet – every day,”Diane Brockmeier,RN, BSN, MHA,president and CEO of Mid-America Transplant OPO, said during the hearing. “DonorNet is outdated, difficult to use and often slow to function when every minute counts. Manual entry subjects it to error, and OPO transplant center staff are not empowered with the right information when time is crucial,” Brockmeier told the committee. “The limitations of UNOS technology are delaying and denying transplants to patients dying on the waitlist.”
The contract to manage organ procurement in the United States is awarded and managed by the federal Health Resource Services Administration (HRSA). UNOS has been awarded the contract seven times through repeated bidding for the past 36 years. It works with 57 OPOs through the Organ Procurement Transplant Network (OPTN) to procure organs and delivers organs to transplant centers once the organs are matched with a recipient on the national waitlist.
In December 2014, UNOS introduced the Kidney Allocation System to improve equity in the allocation of organs and reported last year that 41,354 organs were transplanted – a record.
But a 2.5 year investigation by Wyden and the Senate committee into UNOS operations found inadequate monitoring of the performance by OPOs, a number of which were not meeting quotas for delivering donated organs. Hospitals were also doing a poor job preparing organs for shipment, leading to loss of organs for transplantation and some patients died after receiving diseased organs, according to the investigation.
“Between 2010 and 2020, more than 1,100 complaints were filed by patients and families, staff, transplant centers and others,” Wyden said during the hearing. He said he and other committee members reviewed 100,000 UNOS documents totaling more than 500,000 pages.
In testimony, Shepard, who has been CEO of UNOS since 2012, said, “transporting an organ is extremely complex. Something as simple as a courier taking a wrong turn can delay the delivery of an organ.
“That is why we have engaged in several collaborations with the community to improve the transport of organs through the development and adoption of innovative, evidence-based products to ensure patient safety,” Shepard said.
UNOS announced on June 28 that Shepard would be stepping down as CEO in September when his contract ends.
Jayme E. Locke,MD, MPH, FACS, FAST,a transplant surgeon and the director of the division of transplantation surgery at the University of Alabama at Birmingham and the director of the Comprehensive Transplant Institute at the university, said UNOS has not taken responsibility for problems within the organ procurement process.
“Transplantation was always supposed to be about the patient, but the system we operate now has almost a complete lack of ownership and responsibility – whether it is an OPO failing to show up at donor hospitals and engage families or UNOS failing at the most basic responsibilities of getting recovered organs matched and safely to the recipients at the other side,” Locke testified. “These are the government’s own contractors.”
Locke said the poorly monitored OPTN has allowed for the discarding of thousands of kidneys every year.
“Discards have increased steadily, and transportation errors are frequent particularly since the most recent allocation change, as the new [kidney allocation] system increased complexity, and to date, UNOS has shown no ability to manage even simple logistics,” Locke said.
Locke testified that she had to discard four kidneys delivered by four different OPOs in 1 week because of how the organs were prepared for shipment. “Errors happen. We all understand that,” Locke said. “However, opacity at UNOS means that we have no idea how often basic mistakes happen across the country, nor can we have confidence that anything is being done to redress such errors so they don’t keep happening.”
Two of the kidneys that had to be discarded were for highly sensitized Black women, “meaning they were the proverbial needle-in-a-haystack kidneys for patients that are hard to match,” Locke said.
Wyden said the investigation into UNOS will continue with additional hearings.
A system in need of repair: Addressing organizational failures of the U.S.’s Organ Procurement and Transplantation Network. U.S. Senate Committee on Finance hearing, Wednesday, Aug. 3, 2022.https://www.finance.senate.gov/hearings/a-system-in-need-of-repair-addressing-organizational-failures-of-the-uss-organ-procurement-and-transplantation-network. Published Aug. 3, 2022. Accessed Aug. 5, 2022.