From Waiting Lists to Lifelines: Why We Need New Organ Donation Laws
- kjackkc
- Jul 25
- 7 min read
Updated: Jul 27
Every life matters. The management of organ donation and distribution is extremely complicated; as a result, there is always room for improvement. At least that is the company line that the organ procurement and distribution organizations have been selling, and I bought it hook, line, and sinker. Rather than being angry at an imperfect system, my intention was - and still is - to help advocate for positive changes. Sadly, what I have discovered, is that not only is the system "imperfect", quite frankly it is broken.
My goal with this article is to identify ways we can advocate for improvements by contacting our legislators and demanding change. As I conducted research on this topic, I stumbled upon investigative reports published by the New York Times that sent chills down my spine. In fact, I was outraged. If it doesn't outrage you in the same way, I will pray for your eternal soul.
I am of the opinion that educating the public on this topic is critical to driving change. For that reason, I am going to throw some major factoids at you in the paragraphs below.
The Disturbing Truth About Organ Harvesting and Corrupt Allocation Practices
In what should be one of the most tightly regulated and ethically protected processes in modern medicine, a horrifying breach of trust is unfolding across the country. Reports and whistleblower testimonies are shedding light on deeply disturbing practices within the organ procurement and transplant system: patients declared dead while still exhibiting signs of consciousness—and organs being harvested prematurely.
This is not just a scandal; it is a profound violation of human rights and medical ethics, demanding immediate national outrage and intervention. In my mind, this is murder. As someone who has been on the "waiting list", I would rather die than accept an organ that was taken from a person that was actively using it. I could not live with myself knowing someone was actually murdered in order to give me an organ.
At the heart of this controversy is the increasingly murky determination of “circulatory death.” Circulatory death simply means that the heart has stopped beating and breathing has ceased. In several documented cases, patients were pronounced dead within minutes of cardiac arrest—well before brain activity ceased—despite clinical signs indicating residual consciousness. Instead of following clear, conservative protocols, medical professionals are allegedly rushing this declaration to meet organ viability windows, potentially condemning living, sentient individuals to death for the sake of transplantation. Please note that circulatory death differs from organ donation after brain death. Donation after brain death involves the recovery of organs for transplantation after a patient has been declared dead based on neurological criteria, meaning there is irreversible cessation of all brain and brainstem function. While brain dead, the patient's cardiopulmonary function may be artificially maintained, but they are considered legally dead. I honestly thought that Donation after brain death was the standard, and I could not have been more wrong.
Equally appalling is how these organs are distributed. Organ Procurement Organizations (OPOs), which are supposed to operate with impartiality and according to strict national waitlist rules, are reportedly circumventing these safeguards. Instead of allocating organs based solely on urgency and compatibility, some OPOs are allegedly prioritizing favored surgeons, hospitals, and private institutions—turning lifesaving organs into commodities used to strengthen relationships or pad institutional success metrics.
This is not just unethical. It’s criminal.
Families who believed they were saying goodbye to loved ones with dignity and respect are now haunted by the possibility that their relatives were aware—perhaps even conscious—during organ removal. Meanwhile, patients who have waited years on transplant lists die while organs are diverted to hospitals with more influence and better connections.
The U.S. transplant system must be immediately and independently investigated. Federal oversight agencies, medical ethicists, and patient advocacy groups must demand answers:
Who is accountable for the rushed and possibly erroneous determinations of death?
How many patients were prematurely declared dead?
What mechanisms allowed OPOs to bypass the waitlist system?
And who benefited from this exploitation?
Procured Organs Being Wasted
In the United States in 2023, over 10,085 organs recovered for potential transplant were not used—amounting to approximately 19.3% of all organs recovered that year. That equates to more than 1 in 5 donated organs being discarded. In 2024, estimates suggest a comparable scale, with nearly 12,000 potentially life-saving organs tossed, and roughly 1 in 5 donated organs going unused.
Why Are Imperfect Organs Discarded?
Quality and Risk Aversion
Organs flagged as "marginal" (e.g., older donors, elevated KDPI score) have discard rates over 60% because transplant centers fear poor outcomes affecting their accreditation and insurance contracts
Surgeons often decline due to even minor perceived flaws—like minor vasculature injuries or biopsy sample errors—that are fixable yet disqualifying in practice STAT.
Regulatory and Financial Pressures
Hospitals and transplant centers face intense oversight: if a patient's outcome is worse than predicted, institutions risk penalties or loss of status. So they often prefer only the highest-quality organs
Logistics and Transportation Issues
Organs may be damaged, delayed in transit, lost, or arrive less than ideal. Reports include organ coolers lost in airport luggage systems or organs arriving in poor condition due to transport issues.
Allocation Complexity
The allocation process gives surgeons just 30 minutes to make a decision, considering donor-recipient compatibility, travel time, ischemia time, and antibody matches. If any issue arises, an organ can quickly be declined—even after being recovered.
Surgeons may cancel even during retrieval or surgery if they suddenly deem the organ unsuitable—even after the patient is anesthetized or prepped
Why It Matters
This isn’t just about restoring trust in the transplant system. It’s about protecting the sanctity of life, the dignity of death, and the basic principles of fairness and transparency.
Silence is complicity. We must speak up—for the victims, for the families, and for the future integrity of medicine.
New Organ Donation Laws Are Urgently Needed
New Legislation Needed (Proposed to Congress, not yet drafted)
“No Wrong Door” Patient Safety Reporting
Congress should direct HRSA (Health Resources and Services Administration) and CMS (Centers for Medicare and Medicaid Services) to create a comprehensive, “no wrong door” patient safety reporting system to ensure that patient safety events are quickly reported by providers, patients, family members, or anyone who has witnessed or learns of a potential safety incident. Without a comprehensive reporting system, patient safety incidents can fall through the cracks.
Implement a National Tracking System for Unaccompanied Organs in Transit
There is no federally required national tracking system for organs in transit to prevent them from being lost, delayed or damaged. A national, centralized, and compulsory system-wide tracking system would give key organ transplant stakeholders maximum visibility into the transportation of life-saving organs, while enabling thorough investigations of lost or delayed organs, which is critical to implementing systemwide improvements. This concept has been discussed for several years but needs action. In response to Congressional hearings noting that Americans can track their online orders and pizza deliveries but not the whereabouts of lifesaving organs in transit, HRSA can and should direct the OPTN to establish an OPTN policy that mandates the use of tracking devices, at the very least for unaccompanied organs. The technology to do so exists; the policy does not.
Medicare Incentives for Transplant Hospitals to Accept Medically Complex Organs
A policy change to Medicare to compensate transplant hospitals at a higher rate for transplanting more medically complex organs would encourage more hospitals to accept these organs for their patients. This could save more than 5000 avoidable deaths annually.
Pending Legislation Not Yet Enacted
Optimize the Donor Referral Process with Automated Donor Referrals (ADR).
Successful organ transplants depend on information-sharing with OPOs. This reporting is often undertaken manually by overworked hospital staff. It is antiquated and inefficient. An automated referrals system using electronic health records is being piloted by several OPOs and hospitals. Determining best practices and how to adopt this technology across the country would ensure OPOs are automatically alerted about every potential organ donor when a dying patient meets predetermined clinical criteria. Small studies have found a 49 percent increase in donor referrals and a 333 percent increase in organ donors upon implementation of ADR. U.S. Representatives Wittman, Miller-Meeks, McClellan, Costa introduced legislation referred to Energy and Commerce, H.R. 330, the Organ Donation Referral Improvement Act, to require a study to determine how to implement this nationally. U.S. Representatives Van Duyne, Del Bene, Miller, and Costa introduced legislation referred to Ways and Means, H.R. 4470, Removing Burdens From Organ Donation Act, to improve the donor referral process from hospitals to OPOs with software tools. Click here for information regarding contacting members of Congress and the Senate including a sample letter provided by UNOS (United Network For Organ Sharing).
In-Cabin Airline Transportation for Organs
Life-saving organs should never be relegated to airline cargo bays, where they are more prone to damage, loss, or delay because of cargo staffing limitations. It should not take an act of Congress for HRSA and other federal agencies and departments to convene to address the challenge of unaccompanied organs being transported in the cargo of commercial airlines – but it did. UNOS (United Network for Organ Sharing) advocated for a provision in the most recent Federal Aviation Administration (FAA) reauthorization legislation (P.L. 118-63, Section 1102) that would mandate that the Department of Transportation convene relevant agencies and stakeholders to make recommendations regarding best practices to transport organs in the cabin of commercial aircraft to avoid delays, damage, or loss of these life-saving gifts. The FAA released the Organ Transportation Working Group’s final report on May 12, 2025. The report included 20 recommendations for airlines, OPOs and couriers, HRSA, the Transportation Security Administration (TSA), and FAA to support the above-wing transportation of donated organs. These recommendations are viewed as a foundational first step and are advisory in nature. The House Transportation and Infrastructure Committee met in June 2025 to discuss the FAA Reauthorization Act and address concerns about delays in certain provisions. Several advocacy groups have urged the Department of Transportation and the Federal Aviation Administration to expedite the implementation of the recommendations submitted within the report.
Conclusion
The nation’s organ donation and transplant system is founded on trust. To continue to earn and keep that trust, all stakeholders, Congress and the federal government must work collaboratively to continuously improve the system for the benefit of patients and donor families, who deserve a fair, effective and safe organ donation and transplant system.
Call To Action
It is critical that we urge members of Congress and the Senate to expedite the recommendations and resolutions that have been submitted with regard to Organ Procurement, Allocation, and Distribution.