Senator Jerry Moran: The liver transplant system is rigged
While organ shortages can be a life-threatening crisis, Kansas has taken steps to educate students on the importance of organ donation. And it works. Seventy-five percent of Kansans are registered organ donors. Taking additional steps at the national level to educate potential donors may help address the underlying problem, but Kansas should not be penalized for nationwide organ shortages.
In essence, the liver transplant system is biased against patients in certain states simply because of their geographic location. Senator Roy Blunt (R-Missouri) and I have repeatedly challenged changes in national liver distribution policy that are overtaking the Midwest and Southern states. The policy was developed by the United Network for Organ Sharing, a private organization contracted by the Department of Health and Human Services to oversee the nation’s transplant system. UNOS changed its liver distribution policy in December 2018 by adjusting the geographic parameters that determine which patients receive organ donation.
Our concerns about bias in politics are not mere speculation. A November 2021 U.S. Court of Appeals ruling required internal communications between UNOS, a separate organ procurement organization based in New England, and others to be made public as they developed a new liver distribution policy. Hundreds of pages of published emails revealed a clear bias towards the country’s rural areas.
The liver allocation policy that HHS allows to continue despite overwhelming evidence of its injustice is just one example in a long list of shortcomings in the American national transplant system.
During Senate Finance Committee hearings in August, Chairman Ron Wyden (D-Oregon), along with members of both political parties, demanded everything from UNOS CEO Brian Shepard, from damaged or discarded donor organs, imperfect information technology, high patient deaths, and many years. – long queues. At the latest, more than 105,000 Americans remain on the list of organ transplant candidates, and about 6,000 Americans die each year while waiting for an organ transplant, according to the Health Resources and Services Administration.
UNOS’ contract with HHS is due for renewal in September 2023 and should not be renewed. For more than 30 years, UNOS has been HHS’ sole contractor to manage the nation’s transplant system, despite its dubious performance. HHS should follow a recent Senate Finance Committee report recommending the department remove barriers that prevent other nonprofits from competing for the contract.
The contract must be split among several organizations, starting with the separation of the information technology infrastructure component of the system from the rest of the contract. A study by the National Academy of Sciences, Engineering and Medicine recommended that the IT function be moved into a separate contract next year.
Americans in need of organ transplants deserve much more than the current approach. It’s time for HHS and Congress to prioritize system reform, starting with the competitive contract process.
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