When organs get shipped as cargo, delays and losses become disastrous

For tens of thousands of patients anxiously awaiting lifesaving transplants, a new media investigation has provided what must be heart-breaking news on the laxity with which dozens of donated organs get transported, causing them to be lost or delayed “cargo” and rendered unusable.

The nonprofit, independent Kaiser Health News Service and the Center for Investigative Reporting deserve kudos for following up on the jaw-dropping story of how a human heart got left behind in 2018 on a Southwest Airlines flight. Medical specialists involved at the time downplayed the incident, noting that surgeons had not planned a direct transplantation of that heart in a patient in dire shape, taking various of its valves and tissues, instead.

Still, when reporter JoNel Allecia dug into the ghastly gaffe, she found an organ transplant nightmare. As Allecia described it:

“Surgeons themselves often go to hospitals to collect and transport hearts, which survive only four to six hours out of the body. But kidneys and pancreases — which have longer shelf lives — often travel commercial, as cargo. As such, they can end up missing connecting flights or delayed like lost luggage. Worse still, they are typically tracked with a primitive system of phone calls and paper manifests, with no GPS or other electronic tracking required. Transplant surgeons around the country, irate and distressed, told KHN they have lost the chance to transplant otherwise usable kidneys because of logistics.”

As Allecia also found:

“In a nation where nearly 113,000 people are waiting for transplants, scores of organs — mostly kidneys — are discarded after they don’t reach their destination in time. Between 2014 and 2019, nearly 170 organs could not be transplanted and almost 370 endured ‘near misses,’ with delays of two hours or more, after transportation problems, according to an investigation by Kaiser Health News and Reveal from the Center for Investigative Reporting. The media organizations reviewed data from more than 8,800 organ and tissue shipments collected voluntarily and shared upon request by the United Network for Organ Sharing, or UNOS, the nonprofit government contractor that oversees the nation’s transplant system. Twenty-two additional organs classified as transportation ‘failures’ were ultimately able to be transplanted elsewhere.”

KHN and the center reported that what many would consider egregious, laissez-faire handling of critical human parts results from multiple changes in transplant policies and practices. To balance availability and to try to increase equity among recipients nationwide, the experts who run the transplant network have encouraged increased mobility of organs. They might be collected in a region where there are fewer and less ill patients waiting and flown to areas where there are more and sicker potential recipients.

That may sound, in the ideal, like a good idea. But the logistics of shipping donated kidneys or pancreases falls on volunteers, Allecia reported:

“[T]he U.S. relies on a patchwork of 58 nonprofit organizations called organ procurement organizations, or OPOs, to collect the organs from hospitals and package them. Teams from the OPOs monitor surgeries to remove organs from donors and then make sure the organs are properly boxed and labeled for shipping and delivery. From there, however, the OPOs often rely on commercial couriers and airlines, which are not formally held accountable for any ensuing problems. If an airline forgets to put a kidney on a plane or a courier misses a flight because he got lost or stuck in traffic, there is no consequence, said Ginny McBride, executive director of OurLegacy, an OPO in Orlando, Fla.”

While transportation errors or mishaps may outrage patients, their families, and surgeons, it’s a techy topic with those who could reduce the problems — including airlines, UNOS, and others.

They defend themselves by saying organ losses are few — with critics replying even one is a tragedy. They also express caution about major, well-publicized remedies, arguing that attention to flaws in the system may disturb the public and decrease organ donations. This line of thinking includes the notion that passengers might be upset to learn that 10 or so organs each day fly in cargo areas of commercial airliners. Is that shocking, considering that fliers also must know that deceased loved ones and animals (including pets) go in cargo? Really?

Commercial vendors are stepping in, hoping to provide a reliable service to better move precious cargo like transplant organs around the country. And critics note that technology solutions become more accessible, affordable, and ubiquitous by the day: Critics, for example, ask how it is that the transplant system can’t track and can lose lifesaving human materials while enterprises that have popped up out of nowhere can know where a hamburger or a four-pack of toilet paper, ordered online, is at all times and ensure its delivery, fast and without muss or fuss.

In my practice, I see the harms that patients suffer while seeking medical services and their struggles to access and afford safe, efficient, and excellent medical care, especially in urgent and dire circumstances like needing a transplant. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

The volunteers and medical experts who jerry-rigged the national transplant network deserve some credit for their hard work. The Trump Administration and congressional Republicans poked and prodded the system — sometimes for correct reason — throughout 2019.

More work and cooperation clearly are needed to ensure that sick, debilitated patients — many whose lives are at risk — get treated fairly, safely, and well in an expensive, important, and often last-hope means of medical care. We’ve got a lot of work to do to make the national organ donation and transplantation systems even better.