Biden Administration Proposes Overhaul of Organ Transplant System Transcript

The Biden administration announced plans today to overhaul the network that’s run the nation’s organ transplant system for nearly four decades. The United Network for Organ Sharing known as UNOS has faced criticism for inadequately managing the process. In 2022, doctors performed more than 42,000 transplants in the US but there are still 104,234 men, women, and children currently on the organ transplant wait list. And every 10 minutes, another person is added to that list. 17 people die every day waiting for an organ transplant.

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The proposal would open up a competitive bidding process for other organizations to possibly take over the network with a goal of shortening wait times and saving lives. To help us understand why this overhaul is crucial, I’m joined by Dr. Jamye Locke, director of the Division of Transplantation at the Hearsing School of Medicine for the University of Alabama in Birmingham. Dr. Locke, welcome and thanks for joining us. There’s a lot the administration’s plan seeks to do. At the heart of it though is breaking up this network that’s basically operated like a monopoly for almost 40 years. Help us understand how did it come to be that way in the first place?

Yeah, thank you so much. I think in many ways it’s been that way because sort of there’s been a lot of inertia to overcome. In part, it reflects how the National Organ Transplant Act was written and sort of some of the requirements that HRSA has in terms of administering that contract. But it’s great to see a desire to reflect on where we are and how we can get a lot better so that we can help our patients.

So that UNOS system relies basically on a network of more than 50 local organizations to both procure the organs and also help to manage the transplant process. And we should note that network is responsible for increasing the number of transplants performed over the years, but critics say that system has led to vast regional inequities. Where have you seen that shown up?

Well, I think for us in particular in the southeastern United States, particularly when you look at things like kidney disease, there’s no question that recently we’ve seen an increase in the number of transplants, but that really reflects sadly, an opioid crisis. That’s really increased the number of deceased donors as a result of that. But what those numbers don’t reflect is the increase in discards that we’ve seen as a result of some of the new allocation systems and currently due to inefficiencies with our allocation systems as well as logistics. One in four kidneys are actually discarded in the United States or not transplanted. That’s one in four, that’s 25%. And those are really lives that could have been saved if we could have utilized those organs.

There is the issue of the wait list as well. And we should note there have been previous attempts to fix the system. HHS back in 2021 pointed out that black people were four times more likely and Latinos were almost one and a half times more likely than white people to have kidney failure, but are less likely to be on those transplant wait lists and less likely to have transplants. Why is that? Why is it so hard to even get on the wait list in the first place?

That’s a great question. Well, quite frankly, simply put, you have to have resources to be able to complete your evaluation and your workup to make it to the waiting list. So if you look, there are about 700,000 Americans that have kidney failure, fewer than a hundred thousand are currently wait listed for transplants. So we know not all patients who would benefit from transplant ever make it to the waiting list, and that certainly disproportionately impacts people who self-identify as African-American or black and certainly social determinants of health drive a large proportion of this. So you see individuals who are from areas of high social vulnerability struggle to a much larger extent to make it to the waiting list and to achieve transplant.

Dr. Locke, you’re on the front lines of this every day. I have to ask, when you look at this plan, do you believe a competitive process, the proposal as they’ve put it forward, that this can help to fix the system?

I think it certainly can and it certainly can’t hurt. There’s nothing worse than going to clinic and evaluating patients and knowing that even those patients who qualify for wait listing, many of them are going to die before we ever have an opportunity to offer them a transplant. And we know that transplants are life saving, life giving. They are associated with a substantial survival benefit. And what is just so disheartening is to know that in many cases, organs are being discarded simply from logistical challenges, from not getting the organs where they need to go fast enough. Organs have a shelf life. They can only be out of the body for so long. They can only be on ice for so long before they’re no longer good enough to transplant.

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So no matter how good an OPO is at finding an organ or how good a transplant center is at accepting those and doing the transplant, if they don’t get where they’re needed quickly enough, then the game’s over. And so I think anything that can help our system get better, to be more efficient so that we can help those individuals waiting, that’s a win.

Meanwhile, as we mentioned, there are more than a hundred thousand people currently on that wait list. What does this proposal mean for them?

Well, my hope is that it means that they have a new renewed hope for the opportunity to achieve the gift of life in the form of a transplant. My hope is that it gives them a voice. I think this is the Biden administration along with the Senate and the House, which has had bipartisan support saying we need to do better. We need to do more for these individuals who have been waiting and to let them know that they’re not forgotten and that we need to do better collectively to help them achieve this extraordinary gift of like.

That is Dr. Jamye Locke joining us from the University of Alabama at Birmingham. Thank you for your time, doctor.

Thank you.