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April 3, 2025
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After 37 years as a liver transplant surgeon, after performing over 1,000 surgeries, I am now grateful for the success and challenges of the US organ donation and transplant system.
I transplanted my liver into a young pregnant woman who was dying from acute liver failure who recovered and gave birth to a healthy child, then to another child. Three years after my first transplant, I went on scuba diving and was 100 feet below sea level with the same person who is now my instructor. When we first met, his life was in my hands, but suddenly mine was in him. The circle of life was no longer clear to me.
However, I have also seen transplant centers reject organs because they come from people with obesity or diabetics or those who are not in optimal health without long-term cigarettes or alcohol abuse. And I waited hours for the organ to arrive before realising it was being sent to the wrong hospital. The precious time reached the right place and then placed the patient's life on the line to safely implant in time.
A successful system
The United States has the world's most sophisticated and advanced organ donation and transplantation system. There is no other country that is closer to doing more than 48,000 transplants in 2024, and there is no other country that is closer to doing more than the United States, which saw over 1 million in 2022.
Importantly, the system is improving every day. Transplants have increased by 55% over the past decade, with fewer people dying while waiting for a transplant.
However, with over 100,000 people on the waitlist, there is certainly room for strengthening the US system.
In 2023, the law was signed to secure the U.S. Organ Procurement and Transplant Network (OPTN) Act. Modernization plans involve restructuring how systems are managed, from one federal contractor to multi-vendor and multi-contract setups. The goal is to make the system even better as fewer patients wait or die while waiting for a life-saving organ. A goal that we can all agree on.
But change – especially large systematic changes – takes time. I've seen many times how few transplant patients are, so I have to take action right now.
Therefore, United Organ Sharing (UNOS) promotes reform and educates and informs laws and policymakers about changes in life that can now be implemented.
Reform is needed
UNOS manages OPTN, which has been in federal contracts for almost 40 years, and is pushing for these reforms as it is outside the scope of what Optn contractors can do.
First of all, by allowing it to fly in the main cabin of a Comerst plane, like before 9/11, it will improve efficiency and make the kidneys faster, primarily to patients. Airport security and airline policies change regulated donor organs to fly cargo – yes, next to suitcases – causing delays and risking the viability of the organ. Due to transport issues, it is estimated that 2.5% of organs are not in use. By allowing the kidneys to fly in the main cabin, more organs are carefully processed, avoiding delays, damage, losses, and helping people get the transplant they need.
The U.S. Department of Transport and the Federal Aviation Administration working groups are expected to bring stakeholders together to address this issue and provide the solutions recommended this summer. As a supporter of the working group, UNOS is promoting this common-sense solution to bring organs back onto the wings.
Another way to help donor organs safely take to their destination is to mandate tracking of organs in transit. I had waited more than three hours for my liver to arrive, so I was able to transplant it into a critical care patient when I came from a hospital 20 minutes away. Due to misunderstanding, the organ was sent by courier to another hospital. As a surgeon, I cannot emphasize how important each minute is when it comes to organ survival. There's no time to waste. Thankfully, the hospital was close enough so we took the organ to the hospital and successfully transplanted it, saving the patient's life.
A national intensive tracking system for organs in transit may have prevented this from happening that night. This provided the leading transplant experts with maximum real-time visibility into life-saving organ locations, giving me and my surgical team the ability to find organs as soon as they felt time had passed. Transport tracking systems also allow you to investigate organs lost during transport. This is important when implementing improvements.
Furthermore, a way to help more people get the transplants they need is to require referrals to automated donors. Successful transplants rely on rapid and accurate information sharing with nonprofits (OPOs) that recover organs from deceased donors. This information is often sent manually by overworked hospital staff, increasing the risk of misinformation. Automated referrals allow OPOs to be automatically alerted of potential organ donation if the dying patient meets the prescribed clinical criteria. This leads to more life-saving transplants and respect for any gift of life.
And finally, incentives from transplant hospitals and doctors need to accept and transplant difficult organs in the location. Transplant programs are constantly evaluated for the number of positive outcomes they have, and due to the designation of payments, insurance contracts, program status and outstanding centers associated with their assessments, it is difficult for centers to accept organs for “not perfect” or at high risk patients. Monitoring the performance of transplant programs is a necessary factor to ensure wise management of a limited supply of life-saving organs and to strengthen public trust in the system. However, performance standards must be applied in a way that does not act as an obstruction to expand the donor pool.
Changes to Medicare policy could encourage more hospitals to develop the expertise they need to embrace the perfect organ, preventing the deaths of thousands of people each year.
Encourage action
These reforms will make the US organ donation and transplant systems more efficient, more reliable and more powerful. Simply put, they save lives. I hope you will join me in urging Congressional leaders and policymakers to act in reforms that save these lives to further improve America's world-renowned donations and transplant systems.
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Disclosure: Klein reports that he is the United Network's Chief Medical Officer for Organ Sharing.
