Review: U.S. transplant network has major flaws

The system for getting donated kidneys, livers and hearts to desperately ill patients relies on out-of-date technology that has crashed for hours at a time and has never been audited by federal officials for security weaknesses or other serious flaws, according to a confidential government review obtained by the Washington Post.

The mechanics of the entire transplant system must be overhauled, the review concluded, citing aged software, periodic system failures, mistakes in programming and over-reliance on manual input of data.

In its review, completed 18 months ago, the White House’s U.S. Digital Service recommended the government “break up the current monopoly” that the United Network for Organ Sharing, the non-profit agency that operates the transplant system, has held for 36 years. It pushed for separating the contract for technology that powers the network from UNOS’s policy responsibilities, such as deciding how to weigh considerations for transplant eligibility.

About 106,000 people are on the waiting list for organs, the vast majority of them seeking kidneys, according to UNOS. An average of 22 people die each day waiting for organs. In 2021, 41,354 organs were transplanted, a record.

UNOS is overseen by the Health Resources and Services Administration , but that agency has little authority to regulate transplant activity. Its attempts to reform the transplant system have been rejected by UNOS, the report found. Yet HRSA continues to pay UNOS about $6.5 million annually toward its annual operating costs of about $64 million, most of which comes from patient fees.

“In order to properly and equitably support the critical needs of these patients, the ecosystem needs to be vastly restructured,” a team of engineers from the Digital Service wrote in the Jan. 5, 2021, report for HRSA, which is part of the Department of Health and Human Services.

UNOS considers its millions of lines of code to be a trade secret and has said the government would have to buy it outright for $55 million if it ever gave the contract to someone else, according to the report.

Transplant doctors have complained for years about archaic aspects of the technology for sharing data and getting organs to the right place as quickly as possible.

“When nearly 100 percent of hospitals use electronic records, the notion that we rely on human beings to enter data into databases is crazy. It should be 85 to 95 percent automatic,” said University of California at San Francisco surgery vice chair Ryutaro Hirose, a former chair of the UNOS liver transplant policy committee. “We could concentrate more on improving patient care.”