Transplant system in dire need of overhaul, experts say

Senate Finance Committee members and other witnesses slammed the head of the United Network for Organ Sharing (UNOS) at Wednesday’s hearing for the characterization of committee chairman Ron Wyden (D-Ore.)

Witnesses describe organs being delivered in boxes with tire treads or rotting at airports, commission’s 2.5-year investigation found hundreds of organ recipients contracted the disease because

About 6,000 Americans die each year waiting for an organ transplant, Wyden noted. He added that many of these deaths were avoidable, but that UNOS and many of the organ procurement organizations (OPOs) it oversees not only “fail” but are “not interested in improvement”.

“The bottom line is that the failures we found cost lives,” he said.

In November 2020, CMS published new OPO performance standards. More than a third of the 57 entities did not meet the target.

In addition, the technology UNOS uses to run its systems is “outdated, poorly managed and insecure,” Wyden said.

A report released last year by the U.S. Digital Service determined that the network lacked the technical capacity to modernize the system. According to the Washington Post , the report recommends separating the $248 million worth of systems contracts from policy management contracts.

Senator. Elizabeth Warren (D-Mass.) unabashedly told UNOS CEO Brian Shepard, “I’m going to make it clear. You should lose this contract. You shouldn’t be allowed access to the organ transplant system in the process. Nation If you try to interfere with the process of handing over the contract to someone who is really competent for the job, you should be held accountable for that.”

Warren was referring to concerns that UNOS could hold the transplant system hostage , presented by Jayme Locke, MD, MPH, director of the Division of Transplantation at the University of Alabama at Birmingham Helsinck School of Medicine.

Locke said she was disturbed by a Washington Post article that said UNOS “threatened to leave and Continue to operate without a contract, despite the fact that it would be illegal.”

“I would lose my medical license for leaving a patient. If UNOS suggests it is true Leaving or not cooperating with the transition to a new contractor will make it an organization that cannot be responsible for taking care of lives,” she said.

UNOS won the bid

In the early 1980s, the federal government An organization was sought to oversee the first computerized system to match patients with organs, the Organ Procurement and Transplant Network (OPTN), explained Wyden. UNOS won the contract in 1986 and has since made seven more bids.

UNOS oversees a network of nearly 400 members, including 252 transplant centers and 57 regional OPOs. As Senator Chuck Grassley (R-Iowa) explained, the network’s responsibilities are threefold: it manages policy development, technology delivery, and member compliance oversight.

Committee review of 100,000 people UNOS documents reveal ‘shocking’ mistakes in procurement and transplants, including patients, families, transplant centres from 2010 to 2020, Wyden says and 1,100 complaints from staff.

He noted that, for example, the OPO’s failure to provide mandatory testing for blood type, disease and infection resulted in about 249 recipients falling ill from transplanted organs from 2008 to 2015.

“More than a quarter of them died,” he said.

The committee also found 53 complaints related to organ transplants, including missed flights by couriers, and organs abandoned at airports or never collected.

Wyden points out that in decades of oversight, UNOS has only recommended that an OPO lose its certification.

Shepard argues that the OPTN’s authority allows ” Peer Oversight and Quality Improvement” – This role is distinct from CMS’ regulatory certification and oversight role. He also emphasized more than once that “all accreditation and decertification bodies are at CMS.”

But as Wyden later clarified, UNOS does have the right to decertify with reference to CMS under the OPTN final rule the OPO.

At the conclusion of the hearing, Wyden noted that the investigation will continue and will examine the role of federal agencies, including CMS and the Health Resources and Services Administration.

A squashed box and a kidney frozen solid

Among the many bugs highlighted , Locke described a kidney delivered in 2014 as a frozen solid, “like ice cubes you can put in a drink” that had to be thrown in the trash. A few years later, another came in a squashed box with tire tracks on it. Although the container inside was broken, that one was salvageable.

Over a 1 week period in the past May, she has received four kidneys from four different OPOs, all of which are fundamentally wrong. One involved a botched biopsy, and the other involved an artery with an incision that could have been repaired if someone found damage. “The other two were blue, which means they weren’t washed away,” she said. All are unavailable.

It is these errors that are responsible for the 25 percent rejection rate of kidneys in transplant systems, Locke said. She noted that about 8,000 kidneys were lost last year.

Locke says one of the things that frustrates her the most about the porting system is its inability to think outside the box, which is maddening.

She said that a nighttime pipe organ from California to Birmingham, Alabama could be airlifted from San Francisco to Atlanta and then a 2-hour drive to Birmingham by courier. But instead, the organ will be shipped from San Francisco to Atlanta and put into a cargo hold overnight, “and it’s literally rotting.”

Diane Brockmeier, RN, Mid President and CEO – American Transplant in St. Louis and board member of OPTN from 2018 to 2020, had similar frustrations.

“UNOS needs an explanation when OPO throws out organs out of sequence. However, when organs are recovered and thrown away, UNOS is silent,” she said. The system is suppressed. She noted that some members were “ignorant of key issues” and “marginalized” if their views clashed with UNOS’ leadership (the OPTN board and UNOS’s board are currently the same).

In addition, she said that a panel conference call was held prior to the board meeting to “explore voting intent, and if board members disagree with UNOS leadership, a follow-up call will be initiated” , she added, that board members were reportedly forced to align with UNOS leaders.

Brockmeier urges Congress to split OPTN functions into separate contracts, give patients access to “best-in-class providers” and “immediately separate the boards of OPTN and OPTN contractors.. ….to ensure that patients are protected through public data from OPTN and OPO.”

Locke noted, “One of the things we really wanted to know [was], why we didn’t hire Applied math experts to read lly to optimize our matching algorithms and organ placement? Why haven’t we actually hired experts in transportation logistics?”

Every day, thousands of planes fly over the United States simultaneously, The FAA makes sure they don’t run into each other because they know exactly where each plane is, she said, “and we should be able to do the same for our transplant system and our organs.”

UNOS contracts may be re-bid in 2023.