Key facts
- Over 100,000 people in the US were on the national waiting list for an organ transplant as of May 2025.
- The Department of Health and Human Services (HHS) oversees the organ transplantation system.
- HHS has not developed specific plans to implement the next phase of its modernization initiative to address identified weaknesses.
- Concerns have been raised about inequitable organ allocation, unused organs, and patient safety.
- In 2024, HHS awarded multiple contracts to assess identified concerns within the organ procurement and transplantation system.
- About 13 people die each year waiting for a transplant.
The US organ transplantation system faces significant systemic issues, including concerns about inequitable organ allocation, unused organs, and patient safety, according to a report by the Government Accountability Office (GAO). As of May 2025, more than 100,000 individuals with severe organ failure were on the national waiting list for a lifesaving transplant. The Department of Health and Human Services (HHS), which oversees the organ transplantation system, has initiated a modernization effort. While HHS has awarded contracts to assess weaknesses in organ allocation services, it has not yet developed detailed plans for the next phase of this initiative, which is crucial for implementing necessary reforms.
GAO's report highlights that policies for organ allocation have disadvantaged certain individuals, with disparities noted based on race, sex, and geographic location. In 2024, 19% of organ allocations were made out-of-sequence, meaning patients who were supposed to receive an organ offer were bypassed. Logistical challenges in transporting and tracking organs have also led to delays or lost deliveries, resulting in some viable organs being declined. Furthermore, the oversight of transplant partners, such as hospitals, and the investigation of patient safety complaints are considered insufficient. For example, a recent HHS investigation found concerning risks due to staff practices at an organ procurement organization, which the Organ Procurement and Transplantation Network (OPTN) initially closed without corrective actions.
Concerns also extend to a contractor providing supplementary services to transplant programs outside of its HHS contract, charging a monthly fee. In fiscal year 2024, this contractor received approximately $9.6 million from transplant programs for services like analytics to manage waiting lists. GAO noted that HHS has not assessed the risks associated with this activity, raising questions about whether these services should be part of the main contract and if transplant programs are aware the fee is optional. GAO recommends that HHS develop detailed plans to address identified weaknesses and improve its oversight of the contractor.