Increased control leads to an improved organ transplant system

For years, the nonprofit groups that coordinate transplants in the United States have routinely flouted federal rules by skipping patients who were at the top of the waiting list and sending organs to those who were not as sick and had not waited as long.

But new federal data shows the rate of skipped patients has fallen by more than half in recent months, a change that reflects widespread efforts to make the transplant system fairer and safer.

“This is really great news for patients and the system,” said Dr. Jesse Roach of the National Kidney Foundation. “We need to continue to monitor it to make sure the system is fair, efficient and transparent. But this is a win.”

The move comes after The New York Times reported last year on widespread problems in the organ donation system, including a sharp increase in bypass patients on waiting lists.

The nonprofits – so-called organ procurement organizations that have contracts in every state to organize transplants – said at the time that they would skip patients only to place organs that were at risk of deterioration and would not be used. But The Times found that they often did so to save time and money and to transport organs to preferred hospitals.

Since then, federal health officials have begun tracking the practice and publishing data online. The rate of skipped patients fell from nearly 20 percent of transplants in 2024 to about 9 percent in recent months. Officials have also promised to tighten rules to end the practice.

The latest data showed that the decline had not led to further organ waste. In fact, organ consumption has increased.

The changes are part of a broader crackdown prompted by The Times’ reporting and pressure from Democrats and Republicans in Congress.

After months of deliberations, the board that oversees the transplant system is poised to adopt a set of guidelines addressing the safety of an increasingly common practice called “donation after circulatory death.”

Unlike most donors, who are brain dead, these donors show some brain activity. But they are on life support, often in comas, and doctors have determined they will never recover. When a donation is approved, doctors withdraw support, wait for the heart to stop, and then remove the organs.

The Times reported last year that the push for more transplants had led to a growing number of rushed cases in which patients endured premature or botched attempts to remove organs. Some potential donors gasped, cried or showed other signs of life. In Alabama, surgeons cut open a woman before realizing she was still alive. Federal investigations uncovered additional cases, including dozens of cases in which Kentucky’s procurement organization ignored signs of increasing vigilance among patients.

The Association of Organ Procurement Organizations, a national trade group, has stressed that security failures are rare.

The proposed rules would require all potential circulatory donors to undergo frequent neurological testing to ensure they do not regain consciousness. It would also give health workers and family members the opportunity to pause the process.

Emily Hilliard, press secretary for the U.S. Department of Health and Human Services, said in a statement that “the reforms are critical to rebuild trust, ensure informed consent and protect the rights of potential donors and their families, as all donors deserve to have their lives honored with dignity.”

Last year, the department closed a procurement organization highlighted by The Times and directed all groups to hire patient safety officers. Health and Human Services Secretary Robert F. Kennedy Jr. said he was continuing to examine the system.

Congress is also investigating. Three congressional committees have held hearings on donor safety in recent months.

“For too long, the system has underperformed the thousands of families waiting for a life-saving transplant, as well as the communities and donors who expect more when they agree to help save a life,” said Sen. Ron Wyden of Oregon, a Democrat who has drafted legislation to improve oversight of donor safety.

The House Ways and Means Committee, which warned in November of procurement problems in New Jersey, recently began investigating another problem reported by the Times: Some hospitals have been taking care of foreign patients who pay more for transplants despite America’s organ shortage.

“It is reprehensible that it now appears that U.S. hospitals, particularly those that enjoy tax-exempt status, have acted as concierge organ clinics, funneling American patients to wealthy foreign nationals willing to pay to skip the line,” said Rep. Jason Smith of Missouri, the committee’s Republican chairman.

Federal health officials have asked the Justice Department to investigate one of the cases reported by The Times involving a Japanese patient who received a heart transplant at the University of Chicago within days of arriving in the United States. Soon after, a charity run by the patient’s husband made a donation to a spiritual organization run by the transplant surgeon’s wife.

None of the parties involved responded seeking comment. Some hospitals described transplants for international patients as humanitarian efforts and denied recipients preferential treatment.

Transplant system officials are investigating several hospitals that serve international patients and have set up a working group to study policy changes.

Hospitals and organ procurement organizations have recognized the need for reform but argued that too much focus on problems could hinder organ donations. Last summer, the nonprofit Donate Life America reported that at least 20,000 people had withdrawn their names as registered donors amid the focus on safety issues. At that time there were around 174 million donor registrations.

This week, a spokeswoman for Donate Life America said no more recent data was available.

Procurement organizations reported a slight decline in the number of organs removed last year, yet U.S. hospitals performed more transplants than ever before – more than 49,000.

Dr. Seth Karp, a transplant surgeon at Vanderbilt University who has testified at congressional hearings about problems in the transplant system, said he was encouraged by the tide of change.

“We are going in the right direction,” said Dr. Carp. “Change is hard, but sometimes necessary. I really believe we are strengthening the system.”