Senate panel assails transplant system for causing deaths and disease

unoslogo-300x190UNOS, the independent medical network responsible for procuring and distributing human organs for transplants in this country, needs big changes because it is failing desperate patients, making screening errors, among other missteps, that have killed dozens of them and caused hundreds to develop procedure-related diseases.

The U.S. Senate Finance Committee reviewed hundreds of thousands of pages of subpoenaed documents and other material and investigated the nation’s transplant network for 2½ years, assailing UNOS  for its operational and oversight laxity, the Washington Post reported:

“Testing errors and overlooked communications [in organ procurement] allowed the transmission of cancer, a rare bacterial infection, and other diseases …The errors included failures to identify disease in donor kidneys, hearts and livers, as well as mix-ups in matching blood types and delays in blood and urine tests that were not completed before transplant surgeries occurred, the investigators concluded in a report obtained by The Washington Post. The Senate committee partly blamed lax oversight of organ procurement organizations (OPOs), the regional nonprofits responsible for collecting donated organs, by the United Network for Organ Sharing (UNOS), the Richmond-based contractor that oversees the system. It listed as problems careless treatment of donated organs, organs lost in transit, and technological issues.”

The newspaper also reported this:

“In 2020, the investigation found, two healthy kidneys were accidentally thrown in the trash in Indiana. In 2015, an airline temporarily lost a donated kidney that was supposed to be shipped from South Carolina to Florida — causing the transplant surgery to be canceled and the organ discarded. In 2017, another kidney was misplaced and missed a flight from South Carolina to California, leading to another canceled transplant, but the organ was used by a local transplant team.”

UNOS declined to comment, saying its leaders had not seen the Senate report. But the organization noted that its efforts, with its partners, had led to an important expansion of life-changing and life-saving transplants — more than 41,000 in 2021. The group provided the newspaper with earlier congressional testimony by UNOS chief executive Brian Shepard, in which he said:

“Ours is a complex [transplant] system; one that is dedicated to continuously improving, monitoring, and adapting; one that involves thousands of people coming together every single day across the country in order to save lives. It is a system Congress set in motion nearly 40 years ago, and which, thanks to the decisions and expertise of those who laid the foundation, allows us to best serve patients in need of a transplant.”

The findings of Senate investigators, however, challenge that optimistic depiction, the Washington Post noted:

“The Senate report examined 1,118 complaints filed from 2010 to 2020 with UNOS. The death toll from failed organ screenings — detailed in a 2016 UNOS report handed over to Senate investigators — covered a shorter time period, 2008 to mid-2015. The deaths and illnesses were a tiny fraction of the 174,338 organs transplanted in that seven-year period. But ’this data illustrates the lethality of diseases contracted during a transplantation and the need for exacting scrutiny of such transmissions,’ the committee wrote in a 60-page memo …”

The newspaper reported that critics have built increasing evidence about “serious weaknesses in the transplant system, which is funded primarily by fees charged to patients awaiting transplants”:

“A confidential government report by the United States Digital Service, completed 18 months ago, called for the technology that powers the system to be completely overhauled. It cited aged software, periodic system failures, mistakes in programming, and overreliance on manual input of data, The Washington Post reported … In February, a study by the prestigious National Academies of Sciences, Engineering and Medicine found the transplant system to be inequitable, with unexplained performance differences across the system. It also said that 1 in 5 procured kidneys is never transplanted.”

Tens of thousands of patients await organ transplants annually, critics say, adding that two dozen of them die daily before suitable organs can be found for them and procedures undertaken. When oversight of the transplant network determines problems exist, Senate investigators found, the penalties are rare and modest.

The investigators — noting that organs, especially kidneys are procured but discarded before transplant and that various parties involved feud over exactly why —suggested that Congress could improve the transplant system by giving it competition, the newspaper reported:

“The Senate committee study recommended that the government create competition for UNOS, which has held the contract to run the transplant network for the entire 36 years of the system’s existence. It also suggested awarding a separate contract for the transplant system’s technology; increasing ‘transparency and accountability for chain of custody and transportation of organs;’ and increasing accountability for lost, damaged, and delayed organs.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, effective, and excellent medical care. This has become an ordeal due to the soaring cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

Let’s give credit where it’s due: Transplant surgery, in popular lore, has become one of modern medicine’s most miraculous practices, not only saving individual lives but also blazing new frontiers about the functions of organs in the body and providing insights of large significance into the workings of the human immune system. This progress hasn’t come without considerable cost to health care.

The coronavirus pandemic, of course, has underscored as never before the whopping problems the U.S. health care system has with inequities — based in race, gender, economics, and more. These long have haunted the transplant system, in which the wealthy, in ways that poorer patients cannot, can use their considerable resources to improve their odds of getting organs and undergoing successful procedures.

Popular accounts about transplantation — feature stories with winsome kids or huggable grandmas — often also don’t describe the monetary toll of the procedures. In 2014, for example, almost 2,000 patients had heart transplants, procedures with an estimated, billed cost of $1.2 million each; 29 patients had complex heart-lung transplants, with a price tag of $2.3 million each.  Further, patients typically need to spend time before and after their transplant in serious, hospital care; they then face a lifetime of health challenges, including extensive medication regimens. They spend their own money (for example, to get to and from care) but insurance and government programs often must pick up a big portion of these hefty tabs. In other words, all of us bear a share.

It’s also only rarely discussed but, as current practice holds, the transplant approval process tries to minimize judgments as to how individuals arrived at their need for an organ; those who abuse alcohol or drugs and damage their livers, for example, must demonstrate sobriety for a period while under consideration for transplant — but they are not denied access to the life-saving receipt of an organ.

We have much work to do to see that the transplant system in this country is equitable, safe, efficient, effective, and excellent.

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