Thursday, March 30, 2023

Deceased-donor transplants: UNOS in the crosshairs

 There is unprecedented political will aiming towards reform of the system by which organs for transplant are recovered from deceased donors in the U.S. and allocated to patients in need of a transplant.  Here are two opposing views about current proposals to reform or replace the current government contractor in charge of this system, UNOS, the United Network for Organ Sharing..

From NPR:

The Government's Plan To Fix A Broken Organ Transplant System, March 28, 2023

You can listen here:

"For nearly 40 years, the United Network for Sharing Organs (UNOS) has controlled the organ transplant system.

"But that's about to change. Last week, the government announced plans to completely overhaul the system by breaking up the network's multi-decade monopoly.

"For those who need an organ transplant, the process is far from easy. On average, 17 people die each day awaiting transplants. More than 100,000 people are currently on the transplant waiting list according to the Health Resources and Services Administration.

"UNOS has been criticized for exacerbating the organ shortage. An investigation by the Senate Finance Committee released last year found that the organization lost, discarded, and failed to collect thousands of life-saving organs each year.

"Can the government reverse decades of damage by breaking up control? And what does this move mean for those whose lives are on the line?

"The Washington Post's Health and Medicine Reporter Lenny Bernstein, Federation of American Scientists Senior Fellow Jennifer Erickson, and Director at the Vanderbilt Transplant Center Dr. Seth Karp join us for the conversation. Dr. Karp was also a former board member for The United Network for Sharing Organs


And here's an alternate view, by three professors of surgery at the University of California San Francisco Medical Center, saying that the system isn't badly broken at all, and that attempts to fix it may lead to coordination failures that, at least in the short term, will cause additional problems.

From MedPageToday:

Our Organ Transplant System Isn't the Failure It's Made Out to Be. — Upholding the system will save lives  by Peter G. Stock, MD, PhD, Nancy L. Ascher, MD, PhD, and John P. Roberts, MD, March 24, 2023

"Thanks to a robust network of hospitals, nonprofit organizations, and government support, the U.S. remains a leader in organ transplantation. This community, which is managed by United Network for Organ Sharing (UNOS), saves tens of thousands of lives every year. Despite this success, opponents of UNOS are advocating to dismantle the transplant system as we know it.


"As transplant surgeons with a long history of involvement with the system -- including one of us (Roberts) serving as a past Board President of UNOS/Organ Procurement and Transplantation Network (OPTN) -- we have intimate knowledge of both its successes and its shortcomings. While UNOS has room to improve operationally -- and is working to do so -- we clearly see the organization's life-changing results in our operating rooms and offices. More work lies ahead, however, such as addressing the fact that a rising number of organs are recovered but not transplanted.

"Neither UNOS nor organ procurement organizations (OPOs), which facilitate recovery and organ offers to hospitals, have control over whether medical centers ultimately accept and transplant organs into patients. Though the former two have taken all the blame to date, this remains an issue that concerns the entire system. Leaving our nation's transplant centers out of this critical discussion is a serious oversight. For our entire system to save more lives, transplant centers need to have clear organ acceptance criteria, the appropriate resources to process available organs, and the tools and flexibility to utilize organs from more medically complex donors.


"The recommendations for division of labor as suggested this week by Carole Johnson, administrator of the Health Resources and Services Administration (HRSA), may be well intentioned but present a significant risk of further fragmentation and negative consequences due to a lack of coordination between government agencies and contractors. This coordination is essential for a functional and successful system. UNOS specifically has been handicapped by a meager budget for years, and despite this has a well-developed system. We believe that given the recent 10-fold budget increase by the Biden administration, the current contractor has the potential to rectify the shortcomings that have been highlighted in the press."


Earlier posts:

Sunday, August 14, 2022

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