HHS plans revamp of US organ transplant network with updated IT, more competition

The Biden administration announced Wednesday a planned overhaul of the nation’s Organ Procurement and Transplantation Network (OPTN) that would upgrade its IT system, introduce transparency and—to the delight of critical lawmakers—break up a third-party contractor’s broad control over the system.  

“Our stewardship and oversight of this vital work is a top priority,” Carole Johnson, administrator of the Health Resources and Services Administration (HRSA), which is broadly responsible for overseeing the network, said in a release. “That is why we are taking action to both bring greater transparency to the system and to reform and modernize the OPTN. The individuals and families that depend on this life-saving work deserve no less.”

HRSA said the OPTN Modernization Initiative would “strengthen accountability, equity and performance” of the nearly 400-member network, which currently has more than 104,000 adults and children on its organ waitlist.

The effort relies on more than doubling the existing investment in organ procurement and transplantation to $67 million (as outlined in President Joe Biden’s fiscal year 2024 budget proposal).

It also requires that Congress update the nearly 40-year-old National Organ Transplant Act to allow better resource allocation by HRSA and a broader pool of eligible contract entities “particularly with respect to information technology vendors”.

Speaking in front of legislators Wednesday morning during a Senate Finance Committee hearing, Department of Health and Human Services Secretary Xavier Becerrra said the effort would “call for competition in who becomes a contractor for these organ procurement and transplant services. It will no longer be just one company.”

That company is a private nonprofit contracted by the government called the United Network for Organ Sharing (UNOS). Since 1986, the company has been alone in its work managing the network and coordinating member transplant and procurement organizations.

Both UNOS and the OPTN have come under fire lately from lawmakers on the Senate Finance Committee. Last year, the group issued a report and convened hearings in the summer that focused on “failures” in the organ transplant system that led to deaths.

Its chair, Sen. Ron Wyden, D-Oregon, applauded the administration’s decision to break up UNOS’ “longstanding monopoly contract” and said he would support future bipartisan legislation to improve the network.

“Today’s announcement is a big victory for families across the country who have been fighting for a more effective organ procurement and transplantation system,” Wyden said in a statement. “For too long it’s been clear that UNOS has fallen short of the requirements for this contract and the expectations of Americans waiting for a transplant. I’m pleased that the Biden administration has adopted the committee’s bipartisan recommendations to increase competition for this contract to encourage higher performance and better results.”

UNOS said in a statement that it “supports HRSA’s plan to introduce additional reforms into the nation’s organ donation and transplantation system.”

"We welcome a competitive and open bidding process for the next OPTN contract to advance our efforts to save as many lives as possible, as equitably as possible," the statement continued. "We believe we have the experience and expertise required to best serve the nation’s patients and to help implement HRSA’s proposed initiatives."

The first part of HRSA’s overhaul is a data dashboard sharing de-identified information on donors, procurement, transplant waitlists and recipients, which is live now on HRSA’s website.

Other components of the plan involve increasing the independence of OPTN’s board of directors through the contracting process.

The country’s organ transplant and procurement processes have been on the hot seat this week. Wyden and other senators announced Tuesday they would be investigating organ procurement organizations’ potential “gaming” of how procured pancreata are reported to Medicare. Additionally, an investigation by the Markup and The Washington Post reported that a 2020 policy shift harmed patients in poorer states with higher liver disease death rates.