Biden administration proposes overhaul of organ transplant system

The Biden administration announced plans to overhaul the network that has run the nation’s organ transplant system for nearly four decades. The United Network for Organ Sharing has faced criticism for inadequately managing the process. The proposal would open up bidding for other organizations to take over the network to shorten wait times. Amna Nawaz discussed the latest with Dr. Jayme Locke.

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  • Amna Nawaz:

    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 U.S., 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.

    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. Jayme Locke, director of the Division of Transplantation at the Heersink 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?

    Dr. Jayme Locke, Heersink School of Medicine, University of Alabama at Birmingham: Yes, 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.

  • Amna Nawaz:

    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?

  • Dr. Jayme Locke:

    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 have 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 have 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, are not transplanted.

    That's one in four. That's 25 percent. And those are really lives that could have been saved if we could have utilized those organs.

  • Amna Nawaz:

    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?

  • Dr. Jayme Locke:

    It'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 100,000 are currently wait-listed for transplant.

    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.

  • Amna Nawaz:

    Dr. Locke, you — 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 have put it forward, that this can help to fix the system?

  • Dr. Jayme Locke:

    I think it certainly can. And it certainly can't hurt.

    There's nothing worse than going into 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 lifesaving, 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.

    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 it — the game is 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.

  • Amna Nawaz:

    Meanwhile, as we mentioned, there are more than 100,000 people currently on that wait-list.

    What does this proposal mean for them?

  • Dr. Jayme Locke:

    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 life.

  • Amna Nawaz:

    That is Dr. Jayme Locke joining us from the University of Alabama at Birmingham.

    Thank you for your time, Doctor.

  • Dr. Jayme Locke:

    Thank you.

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