Breaking up human organ monopolies

Excerpts from recent editorials in the United States and abroad:

The Washington Post on breaking up human organ monopolies

A proposed overhaul of the system that governs how human organs are procured, transported and transplanted in the United States could save many lives — if the Biden administration succeeds in breaking up the monopoly of the network that currently runs it.

Some 106,000 Americans are on an organ waiting list, and 22 die each day in want of organs such as kidneys, livers and hearts, according to the National Academies of Sciences, Engineering and Medicine. Many of these deaths are preventable. A 2018 Post analysis found that tens of thousands of potentially usable organs go uncollected every year. If this resource were better managed, the organ waitlist could be substantially cut or eliminated. More people would live.

A big part of the problem is that monopolies run the organ procurement system. Across the country, 56 “organ procurement organizations” have exclusive control over collecting organs in their respective regions. On the national level, the United Network for Organ Sharing (UNOS), a quasi-governmental agency, is supposed to oversee these regional organ procurers and run the logistical operation that matches organs with doctors, hospitals, labs and, ultimately, patients. Yet UNOS, too, is effectively a monopoly, having held the contract for running the system since it was created nearly 40 years ago.

With no competition, performance suffers. Independent reviews have found big problems, particularly in the technology UNOS uses to get organs from organ procurement organizations to the right patients at the right transplant centers, which critics complain still relies excessively on manual data entry. The system is prone to crashing, as it did for 40 minutes in February. This sort of failure could render unhealthy a freshly procured organ if it meant a delay in transporting it.

Nationally, more than one-fifth of recovered kidneys are not transplanted into needy people, a rate far worse than in peer European countries. There have been preventable — and deadly — snafus. A Senate Finance Committee investigation attributed 70 deaths and 249 illnesses to mistakes in organ screening before transplantation. A well-meaning reform meant to get organs transplanted into the sickest patients first appears to have led to a rise in the number of wasted livers, according to a new Post analysis.

Organ transplant system officials are “15 times more likely to lose or damage an organ in transit as an airline is to lose or damage your luggage,” Sen. Elizabeth Warren (D-Mass.) said in a hearing last year. Sen. Charles E. Grassley (R-Iowa) noted accusations that the system is rife with “fraud, waste and abuse, criminality, deadly patient safety issues, and failure to recover organs.”

UNOS’s contract with the federal government is up for renewal this year, and Biden administration officials proposed Wednesday some major reforms. One reason UNOS has typically encountered little competition for the contract to run the organ transplant system is that there are few entities that can operate a logistics network and perform all of UNOS’s other tasks. So, federal officials want to break UNOS’s functions into separate contracts, attracting companies to bid for the opportunity to operate specific parts of the system. This could be particularly helpful if it induced companies that specialize in complex logistics to seek the contract to improve the organ transplant system’s IT operations; if organ logistics were operated as efficiently as FedEx package delivery, fewer may be lost.

Biden administration officials say they have the legal authority they need to proceed. But Congress should provide any funds that might be required, particularly to make the new contracts more attractive to outside companies. Lawmakers should also review the statutes governing the organ transplant system, ensuring that the administrations have all necessary powers.

There are other things that should be done as well to improve the system. Even a more efficient logistical operation cannot maximize the number of organs collected. That is why organ procurement officials should explore new avenues to persuade more deceased people’s families to allow organ donations. They should also promote the use of organs from less-than-ideal candidates, such as older people or those who have certain infections. There is reticence among some in the United States to accept such organs — but an imperfect liver is better than none for those on the waiting list. Once organs are removed from the body, it is vital that they move to their new hosts quickly, which requires better coordination among surgeons and hospitals so they are on call to operate.

U.S. officials should ensure that the organizations they put in charge of these efforts are up to the task. That will be much easier if the Biden administration stays on course.


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