The US tallied its millionth organ transplant on Friday, a milestone that comes at a critical time for Americans still desperately waiting for that chance at survival.
It took decades since the first success — a kidney in 1954 — to transplant 1 million organs, and officials can’t say whether that last one was also a kidney or some other organ. But campaigners have launched a new campaign to speed up the next million transplants by encouraging more people to register as organ donors.
However, the country’s transplant system is at a crossroads. More people than ever are getting new organs — a record 41,356 last year alone. At the same time, critics criticize the system for policies and outright mistakes that waste organs and cost lives.
Anger flared last month at a Senate committee hearing, where lawmakers accused the United Network for Organ Sharing, a nonprofit that has a government contract to run the transplant system, of cumbersome organ tracking and poor oversight.
“This is sitting on your hands while people are dying,” Sen. Elizabeth Warren, D-Massachusetts, told the agency’s chief executive as she and other senators proposed replacing UNOS.
UNOS is constantly taking steps to improve organ supply and equity and will not be satisfied until everyone who needs a transplant receives one, CEO Brian Shepard responded.
Other experts say fireworks distract from work already underway.
“Everyone would like the system to be better,” said Renee Landers, a University of Suffolk health law expert who, as part of an independent scientific advisory panel to the government, authored a plan for change earlier this year.
That plan, from the National Academies of Sciences, Engineering and Medicine, sets a five-year deadline for improving every part of the complex transplant system — including the teams that collect organs from deceased donors, the transplant centers that decide which ones to use and government agencies which regulate both.
“Focusing on just one aspect isn’t really going to achieve” that goal, Landers said. “There are so many other pieces that need to fall into place.”
In the US, more than 400,000 people are living with functioning transplant organs, UNOS reported Friday. For all the lives saved each year, more than 105,000 people are on the national list still waiting for a new kidney, liver, heart or other organ, and about 17 a day die waiting.
Too often potentially usable organs are not being retrieved from would-be donors, and too many hospitals are turning away less-than-perfect organs that could still provide a good outcome for the right patient, according to the National Academies report.
Kidneys are the most requested organ and almost a quarter of those donated last year were discarded and refused by hospitals for various reasons.
A Senate Finance Committee investigation showed additional problems, including testing failures that between 2008 and 2015 led to 249 transplant recipients developing diseases from organ donations, 70 of whom died. In other cases, organs sent from one hospital to another were lost in transit or delayed so long that they could not be used.
While these types of mistakes should never happen, they are a small fraction of the tens of thousands of transplants performed during this time period.
The solutions to the most common problems — getting more instruments and ensuring they are used — are harder, but efforts are being made:
–Kidney transplants rose 16% last year — and by 23% among black patients — attributed to a UNOS-mandated change in how organs are allocated that allows kidneys to be sent to sicker patients instead of being offered to hospitals first close to where they were given.
–In July, UNOS told hospitals to stop using a particular formula for testing kidney function that can underestimate black patients’ need for a transplant and leave them waiting longer than similarly ill white patients.
–Some “organ procurement organizations” or OPOs retrieve organs from deceased donors at much higher rates than others. Medicare finalized new rules this year that require improvement, or low performers could be shut down in 2026.
—OPOs are reluctant to retrieve less-than-perfect organs that they know nearby hospitals won’t accept. Some hospitals may always refuse kidneys from donors over 70 or diabetics, for example. But soon, transplant centers’ kidney acceptance rates will be tracked as a new quality measure.
To prepare, dozens of hospitals are using new computer filters to opt out of even receiving offers they don’t intend to accept. Skipping them could allow those offers to get to places like Yale University’s transplant center — known for success with less-than-perfect kidneys — more quickly before organs sit on ice too long to be used.
“You can’t criticize OPOs for not retrieving organs if you don’t start holding transplant programs accountable for the decisions they make,” said kidney specialist Dr. Richard Formica, director of transplant medicine at Yale. “We need to find ways to motivate people to change their behavior.”
The Associated Press Health and Science Section is supported by the Howard Hughes Medical Institute Science Education Division. AP is solely responsible for all content.