A nationwide debate is raging on about the U.S. organ transplant system: whether it’s the best one in the world or a mismanaged mess; whether it’s rooted in the latest technologies or stuck with outdated tools; and most recently, whether the system should keep being run by non-profit organizations or turned over to for-profit companies.
The outcome of this debate, which is now in the hands of the federal government, will be settled this year, thereby deciding the fates of over 100,000 American patients currently waiting for organ transplants — and all others who come after them.
All organ donations and transplants in the U.S. are facilitated through the Organ Procurement and Transplantation Network (OPTN), a one-of-a-kind public-private partnership that represents each of the roles that make transplants possible. Established by Congress in the 1980s, the OPTN’s membership includes transplant hospitals, laboratories and organ procurement organizations (OPOs) — regional non-profits responsible for organ recovery and transportation.
At the helm is the “OPTN contractor,” a role assigned by the U.S. Health Resources and Services Administration to run the computer systems that match donor organs with registered patients and lead the transplant community in pursuing new policies and technologies.
In our experience, the transplant system has worked wonders, breaking records yearly and saving over a million patients in need, including one of us — Glenda Daggert, who is now 24 years post-transplant. Her dual kidney and pancreas transplant gave her a longer life and precious time to celebrate 48 years of marriage and see her grandchildren grow up.
Glenda’s transplant surgeon at New York-Presbyterian-Weill Cornell Medical Center taught us that organ transplantation is a team sport. It takes not only the surgeon and the nephrologist, but also the cardiologist, the gastroenterologist and all the other ‘-ologists’ working together.
Then there are also the U.S. Department of Health and Human Services, the OPOs, the labs, and countless volunteers who help advocate for organ donation. It takes all of these people working in unison every single day for the system to function.
However, not everyone agrees that it’s functioning as well as it should. Last year, the federal government announced plans for sweeping reforms in response to reports of widespread mismanagement, inequities and overall underperformance across the OPTN. Their solution was to pass new legislation, which became law in September, to allow for-profit companies, without any prior experience in organ donation or transplant, to manage the system for the first time ever. Since then, major tech corporations such as Google and Microsoft have been preparing to disrupt this unique sector of U.S. health care.
The OPTN contractor role is being split into multiple contracts that any company, even for-profits, can bid upon. On Feb. 6, the Health Resources and Services Administration began soliciting bids for two of those contracts, with submissions due in late June.
We don’t think that the current system is perfect. Seventeen people die every day waiting for a transplant, so improvements can and should be pursued. But we should focus on what actually needs to be fixed, rather than let corporate America play musical chairs over who gets to profit from organ donations.
Any groups that manage the transplant system would face the same challenges that exist today. For example, too many organs are collected from donors only to go to waste because transplant teams at hospitals have varying standards for what types of organs they are willing to accept. One solution currently being tested is the introduction of new technologies that make the organ allocation process more efficient.
Transportation is another issue. More and more organs need to be flown on planes to their intended patients but are forced to go through the same procedures (and delays) as regular cargo due to federal security laws, leading to even more waste and missed opportunities to save lives. OPTN leadership has been working with lawmakers to address those barriers by adding new rules in the next FAA reauthorization bill. However, the bill has been delayed by ongoing debates in the Senate.
We do not consider it wise to entrust people’s lives to the whims of Google, Oracle or some other multi-billion dollar corporation. Sicker patients, who are currently prioritized for transplants, are often harder and more costly to treat than healthier patients. What will happen to those people under a for-profit transplant system?
As officials at the Health Resources and Services Administration pick new entities to manage the OPTN, we pray that they see through the corporate sales decks and remember that none of the challenges in the organ transplant field have easy solutions. The system is complex, relying on thousands of professionals working around the clock to save lives.
Any major changes must be weighed carefully, or else countless patients may suffer. We can’t afford to sell them out.
Glenda R. Daggert received a kidney and pancreas transplant in 1999 after living nearly 40 years with type one diabetes. She and her husband, Ira J. Copperman, volunteer together at numerous organ donation advocacy and patient support non-profits, including Transplant Recipients International Organization, Transplant Support Organization, Donate Life New York State and LiveOnNY, the federally-chartered organ procurement organization for New York City.
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