Organ Transplants

More than 10,000 people died waiting for organ transplants during a recent five-year period. Although the technology for organ transplantation has improved dramatically, organ supplies have not kept pace with demand. Federal legislation has attempted to boost supplies of transplant organs and make their allocation more equitable, but patients have little assurance that organs are being distributed fairly. First, the Department of Health and Human Services (HHS) does not monitor the allocation practices of organ procurement organizations. Second, some organizations limit the pool of patients to be considered for transplant to a single transplant center. Third, some organizations do not document why good transplant candidates were skipped over. Fourth, despite a policy of the United Network for Organ Sharing that allocation practices should be uniform, compliance with this policy by organ procurement organizations is voluntary. HHS needs to develop federal regulations stipulating appropriate allocation practices and develop a measure of procurement success that would enable it to target technical assistance to less effective organ procurement organizations. GAO summarized this report in testimony before Congress; see: Organ Transplants: Increased Effort Needed to Boost Supply and Ensure Equitable Distribution of Organs, by Mark V. Nadel, Associate Director for National and Public Health Issues, before the Subcommittee on Health and the Environment, House Committee on Energy and Commerce. GAO/T-HRD-93-17, Apr. 22, 1993 (nine pages).

GAO found that: (1) potential organ transplant recipients cannot be assured that organ allocation decisions are equitable or based on medical criteria because OPO lack standardized organ allocation and procurement procedures; (2) HHS cannot adequately oversee or assess the equity of the organ allocation process because of the lack of information on OPO patient selection processes, insufficient patient selection documentation, the lack of federal regulations on procurement and allocation policies, and differences in OPO center donor acceptance criteria, choice of staff, organ procurement techniques, and minority targeting; (3) although OPO collect data on their own organ procurement and allocation programs, the Health Resources and Service Administration has not provided adequate assessment criteria guidance, requested OPO to disclose data, or required the Organ Procurement and Transplantation Network contractor to collect and submit the information; and (4) HHS and the Network contractor cannot effectively target ineffective OPO with technical assistance because of a lack of procurement performance information.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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