For its investigative report, the Times reviewed two national organ transplant databases, identifying skipped patients through allocation records and “bypass codes,” along with those high on waiting lists who died without transplants. Reporters also interviewed more than 275 stakeholders in the U.S. transplant system, including current and former staff members at procurement organizations and transplant hospitals, along with patients and regulators.
Six takeaways from the report:
1. Organ procurement organizations have faced increased pressure from the federal government to improve efficiency in recent years. As a result, many organizations are “routinely prioritizing ease over fairness,” the Times wrote.
2. Hospitals are also given broad discretion to determine which patients receive donor organs, with decisions sometimes made independently of waiting list rankings, according to the report. The Times identified more than a dozen hospitals that had developed internal “hot lists” to prioritize certain candidates.
3. In 2024, nearly 20% of transplants from deceased donors bypassed patients on waiting lists, representing a sixfold increase from just a few years ago, the Times found. The report suggests hundreds to thousands of patients on waiting lists are skipped, with donor organs going to recipients who are lower acuity or have been waiting for a shorter period of time. In addition, more than 1,200 people have died in the last five years after reaching the top of waiting lists but being skipped for a donor organ, the analysis found.
4. Federal regulators have been aware of patients being increasingly skipped on wait lists since 2022, but have taken little action, the report claims. The United Network for Organ Sharing, contracted by the federal government to oversee the U.S. transplant system, has an oversight committee that reviews these situations. However, the committee rarely intervenes, closing more than 99.5% of cases without action. The rationale is often that organs would have been wasted if patients were not bypassed, although data show the rate of discarded organs has increased alongside this practice, according to the Times.
5. The Health Resources and Services Administration, which oversees UNOS, ordered increased oversight of organ allocation last week after reviewing a summary of the Times‘ findings. The agency told UNOS that organ procurement organizations should not be permitted to sway from waiting lists.
6. In a Feb. 27 statement shared with Becker’s, UNOS said it is dedicated to improving patient outcomes and ensuring fair and equitable transplants.
“It’s no secret that the donation and transplant community wants to allocate organs as equitably as possible according to the [Organ Procurement and Transplantation Network’s] allocation algorithms, and that in resorting to allocations out of sequence, the community strives to maximize organ utilization and minimize the impact on equity. It’s been a frequent topic of OPTN committee meetings, and we all are working toward a solution, but the issue is far more complex than The New York Times story suggests,” an UNOS spokesperson said.
“UNOS, as the federal contractor overseeing the OPTN, has been highlighting through monthly reports the data related to organ allocation out of sequence and has suggested to HRSA multiple ways to try to improve the approach. The OPTN has long wanted to act on the issue. It wasn’t until six months after HRSA received a critical comment about AOOS that it took action. Just days before The New York Times article was published HRSA instructed UNOS — as the OPTN contractor — to submit a plan to HRSA to change various policies, data collection techniques, hospital education procedures and compliance practices.”
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