President Biden signs bill reforming organ transplant system

Woman holding a paper liver in front of her abdomen

Each day in the United States, 17 people die while waiting for an organ transplant, according to Donate Life America. But those patiently awaiting a life-saving organ transplant might soon have good news. On Sept. 22, President Biden signed into law a bipartisan bill, the U.S. Organ Procurement and Transplantation Network Act, to overhaul the country’s organ transplant system.

“In the United States, we transplant kidneys, livers, hearts, lungs, pancreata and intestines,” says Nebraska Medicine nephrologist Clifford Miles, MD. “There are more than 140,000 people on the transplant list, and kidneys are the most frequently needed, followed by livers. Those in need of a kidney transplant can live on dialysis for years. In comparison, if someone has complete liver failure, it’s difficult to keep them alive without a transplant.”

Most people needing a kidney will wait about three to five years on the national transplant waiting list. Of the 17 people who die daily needing an organ transplant, 12 of them are waiting for a kidney.

The bill aims to increase competition among contractors, gain additional funding and improve the Organ Procurement and Transplantation Network, or OPTN. White House press secretary Karine Jean-Pierre told reporters that the new law will break up the monopoly system of single private nonprofits on the OPTN.

Dr. Miles says the OPTN coordinates and manages organ procurement, allocation and transplantation. Since 1987, the United Network for Organ Sharing, or UNOS, has been the only entity to manage the OPTN through a contract with the Health Resources and Services Administration, or HRSA.

UNOS is a private non-profit organization that manages the organ transplantation system under contract with the federal government. UNOS has been criticized over the years, and a Senate Finance Committee reported that the “broken system” caused long waits for organ transplants, leading to deaths. According to the National Library of Medicine, white patients are more likely than Black patients to be rated as “appropriate candidates” for organ transplantation.

“There’s evidence that people of color and those in lower socio-economic statuses are less likely to get organ transplants,” says Dr. Miles. “Some of the reform aims to fix the disparities and inefficiencies in the process, anywhere from managing organ donors to procurement, as well as scrutiny of the transport. Organs rarely get lost during transport, but it has happened.”

Part of the scrutiny, Dr. Miles says, is that one entity controls the entire OPTN contract, which made sense when the organ transplantation system and need for organs was smaller.

“The number of donors and patients that need an organ transplant has grown exponentially. The system has outgrown itself,” says Dr Miles. “The most objective thing that will happen is HRSA will introduce multiple contracts instead of one. There could be four or five contracts, depending on how it’s split up.”

Splitting up contracts as well as modifying organ allocation is a process that could take a few years, Dr. Miles explains. HRSA’s open bidding on new contracts is intended to broaden eligibility criteria, remove unnecessary barriers, and promote transparency, accountability and oversight.

While organ donation from deceased individuals is quite common, living organ donation for kidneys and livers is also possible. It can dramatically decrease a person’s time spent waiting for a transplant. The Nebraska Medicine transplant team has extensive experience in transplantation with living donors and has had great success organizing large-scale living donor kidney transplant chains.

To learn more about becoming a living organ donor, visit