This editorial ran in The Washington Post on March 31, 2023.

Organ donation is one of the most remarkable medical breakthroughs of the 20th century, and it attests to the generous sacrifices of organ donors and their families who provide their friends, neighbors and even strangers a second chance at life. But up until last week, the odds were against those living in the Midwest to receive a lifesaving liver.

For years, we raised the alarm about the nation’s fundamentally unfair organ transplant system, its contractor and the inherent bias of the most recent liver transplant rule. Our warnings were heeded when The Post broke the news that Health and Human Services Department acknowledged its intent to overhaul the organ transplant system and divide up the Organ Procurement and Transplantation Network (OPTN) contract to hopefully end United Network for Organ Sharing’s (UNOS) suffocating grip on the organ donation system.

Our initial distrust of UNOS, the contractor that runs the transplantation network, began when it changed the liver allocation policy by adjusting the geographic parameters guiding which patients receive donated organs. This decision disregarded expert opinion and meant that states with high rates of donation — mostly in the Midwest and the South — had to ship their organs to states with low rates of organ donation, which is made up of mostly urban coastal areas.

Internal communications from UNOS released in 2021 demonstrated that UNOS colluded against certain regions when it issued the new liver allocation policy. The policy process was designed to deliberately deny patients in certain parts of the country their fair chance at a lifesaving liver transplant.

Breaking up the OPTN contract and adding transparency to the process are good first steps to rectify the fundamental bias in the system dominated by a monopolistic contractor. Getting the organ transplant and donation system right is a matter of life and death. There is no room for bias, reckless mistakes or an opaque process. It is important to continue oversight and make certain the organ donation process is transparent and fair so that more organs can be donated and more lives saved.

U.S. Senator Jerry Moran
The writer, a Republican who represents Kansas in the U.S. Senate, is a member of the Senate Appropriations subcommittee on labor, health and human hervices, education, and related agencies.

Roy Blunt
The writer, a Republican, represented Missouri in the U.S. Senate from 2011 to 2023, and was a member of the Appropriations subcommittee on labor, health and human services, education, and related agencies.