The federal government will break up the contract to oversee organ transplantation in the United States, a blow to the Richmond-based United Network for Organ Sharing, which has been the contract’s sole operator for almost 40 years.
In an announcement Wednesday, the Health Resources and Services Administration (HRSA), which oversees UNOS, said it would reform, modernize and bring transparency to the transplantation of kidneys, livers and other organs.
The split comes after years of criticism toward UNOS and a Congressional investigation in which critics said UNOS’ technology is out of date, the number of transplanted organs falls short of expectation and that UNOS failed to discipline its struggling member organizations.
Those missteps have led to patient deaths and an increased call for care, five U.S. senators said in a hearing last year.
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“For too long it’s been clear that UNOS has fallen short of the requirements for this contract and the expectations of Americans waiting for a transplant,” Sen. Ron Wyden, D-Ore., said Wednesday in a statement. “Today’s announcement is a big victory for families across the country who have been fighting for a more effective organ procurement and transplantation system.”
In 1986, UNOS won the first federal contract to manage organ transplantation in the country. It has won every contract since, but the contract expires this year. The deal is worth $6.5 million annually for UNOS.
Located on North Fourth Street in downtown, UNOS has 450 employees, according to its website. The nonprofit welcomes a competitive bidding process, said Anne Paschke, a UNOS spokesperson.
“We believe we have the experience and expertise required to best serve the nation’s patients and to help implement HRSA’s proposed initiative,” Paschke said.
As part of its investigation, the Senate Finance Committee recommended the management of organ transplantation be split into five contracts: policy development, compliance, patient safety monitoring, IT infrastructure and logistics.
Molly McCarthy, a three-time kidney transplant recipient and vice chair of UNOS’ patient advisory committee, said numerous organizations inside and outside organ transplantation could vie for these contracts. Any number of large technology providers in the U.S. could improve upon UNOS’ IT infrastructure, and even online retail giant Amazon could improve its logistics.
“You don’t have to have an MD to run most of the parts of the business,” McCarthy said.
Other organizations that handle living kidney donation, such as the National Kidney Donation Organization, could handle policy development.
HRSA also said it will modernize the IT system on which organ transplantation depends. Diane Brockmeier, the CEO of Mid-America Transplant, a regional organ procurement organization, said last summer that UNOS’ software is slow and out of date. The White House’s United States Digital Services issued a report criticizing UNOS’ technological capabilities, saying staffers enter data by hand, leading to error.
Brian Shepard, who resigned as CEO of UNOS last year, defended UNOS’s technology in August, saying it is operational almost 100% of the time.
On Wednesday, UNOS said it is committed to working with the federal government and others “to assist in carrying out these reforms and to do our part to improve how we serve America’s organ donors, transplant patients and their families.”
Logistical errors plague organ transplantation. After an organ is removed from a recently deceased donor, there’s no guarantee it will arrive in the body of a needy patient.
One in four kidneys taken from a donor never makes it to a recipient, Dr. Jayme Locke, head of transplantation at the University of Alabama-Birmingham, testified before Congress. Kidneys aren’t always tracked during transportation. One arrived to Locke with tire marks on its package. Another was left overnight in the Atlanta airport. Others arrive unusable, the victim of a botched biopsy.
UNOS offers a tracking system, but some organ procurement organizations opted out, finding it too expensive or too inefficient.
A Kaiser Health News investigation in 2020 found that UNOS is 15 times more likely to damage an organ in transit than an airline is to damage luggage.
In the past three decades, nearly 250 patients have developed a disease because they received infected organs, leading to 70 deaths, Sen. Elizabeth Warren, D-Mass., said in August.
Senators have criticized UNOS’ inability to discipline the member organizations that procure organs. UNOS oversees 57 regional organ procurement organizations, and a third of them in 2022 were failing to meet standards, according to the Centers for Medicare & Medicaid Services. But UNOS rarely disciplines those organizations.
Brian Shepard, who resigned as CEO of UNOS last year, told Congress that UNOS’ job is to improve those organizations, not discipline them. That’s CMS’ duty, he said.
On Wednesday, HRSA said it plans to strengthen accountability and performance in organ transplantation. UNOS stands with HRSA and shares those goals, Paschke said.