The US transplant system must be overhauled to stop organ waste and give more patients a fair chance to have life-saving surgery, says an influential scientific advisory group that has set a five-year deadline for changing course.
The United States performed a record number of kidney, liver and other organ transplants last year, more than 41,000 - the vast majority thanks to donations from the dead. But for all the lives saved, Friday's report from the prestigious National Academies of Sciences, Engineering and Medicine highlights the issues that are holding back even more savings.
More than 106,000 patients are on the national list for a deceased donor transplant, and at least 17 die every day while waiting. Many other people who could benefit from a transplant are never put on the waiting list, especially people of color, the report points out. Among other challenges, geography makes a difference to how long sick people wait for a match - and whether potentially usable organs are recovered when potential donors die. And too often, less than perfect organs go unused.
"While the transplant system does many good things and saves many lives, it is grossly unfair and not working for enough people," said Dr. Kenneth Kizer, a well-known quality of care expert from health and chairman of the panel, told The Associated Press. "A lot can be done to make the system work better for more people."
Among the main conclusions of the panel:
-- The Department of Health and Human Services, which regulates the transplant system, should set national performance goals that include completing at least 50,000 transplants a year by 2026. Transplants have been on the rise for years , but reaching this goal would require acceleration.
-- Hospitals must reduce organ waste and be open to patients about the option of an imperfect supply. For example, Kizer said nearly 25% of donated kidneys have not been used in the past year, a level the panel hopes to lower to 5% or less by 2026. Studies have shown that French surgeons routinely implant lower-quality kidneys from older donors than their American counterparts, with similar success. But not all hospitals approve the use of such organs, and Kizer said too often patients are never told when their doctor turns down an opportunity.
"It's too easy for transplant centers to reject viable organs," he said.
-- Congress should hold HHS accountable for reducing inequality within the same time frame. For example, black Americans are three times more likely to have kidney failure than whites, but are much less likely to be referred for transplant evaluation. They wait longer for an organ from a deceased donor and are less likely to find a living donor.
The expert panel recommended several steps to reduce these disparities, but perhaps the most ambitious: the federal government should begin its regulatory oversight as soon as patients are diagnosed with organ failure - rather than waiting for they end up on the transplant waiting list.
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The academies' report contains only recommendations, although the panel's review of the transplant system was conducted at the request of Congress.
The Biden administration said Friday it would consider the recommendations when it begins a previously scheduled renegotiation of the federal contract to make the transplant system work.
“HHS intends to use the tools available to us to further enhance oversight and accountability to the contractor receiving the award,” said a spokesperson for the HHS Health Resources and Services Administration. HHS in a statement.
Some changes were already underway. The United Network for Organ Sharing, which now runs the transplant system, has updated guidelines to reduce inequities, including changing the distribution of organs to make a patient's zip code less important - changes sometimes blocked by lawsuits from rival transplant centers.
And under the Trump administration, Medicare has set new standards to improve the various performance of groups across the country tasked with collecting organs from deceased donors and purchasing them.