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More transplants, more saved lives: The demand and supply for human donor organs must be better matched

It’s a now-taken-for-granted miracle that each year in these United States, more than 40,000 people have many healthy years added to their lives by getting new kidneys, livers, hearts and, in rare cases, lungs. That’s terrific, but the bureaucratic apparatus that connects people in need to organs isn’t nearly as efficient as it can be. Just in time, the Biden administration is moving to change that by opening up for bid the contract that’s been performed for decades by the United Network for Organ Sharing.

The UNOS and the regional procurement organizations that receive and distribute organs are run by well-meaning and committed professionals. But it’s been apparent for decades now that, given advances in medicine, technology and transportation, there’s got to be a smarter way to replace failing organs.

Even as the 40,000 number is worthy of celebration, 100,000 people are on the waitlist for a new lease on life, and some 12,000 every year die or become too sick to get a transplant while in the queue. Roughly 28,000 organs go unrecovered annually, often for banal reasons. One estimate is that a more efficient distribution of organs overall could save 25,000 lives per year.

Inequities add insult to the injury that is inefficiency. A report released last year by the National Academy of Sciences concluded that “key components of the transplantation system — donor hospitals, organ procurement organizations, transplant centers, and the Organ Procurement and Transplantation Network — suffer from significant variations in performance, which often creates an inefficient and inequitable system. An individual’s chance of referral for transplant evaluation, being added to the waiting list, and receiving a transplant varies greatly based on race and ethnicity, gender, geographic location, socioeconomic status, disability status and immigration status.” To name just one, the wait for an organ for Black patients is on average a year longer than for white patients.

Such inequities should hardly be surprising to a nation where the likelihood of maternal mortality varies sharply by race. But what’s unsurprising can also be unacceptable. Fix this system.

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