STATEMENT

Media Contact:
Jenny Daigle | [email protected]

AOPO Statement on The New York Times Coverage of Organ Allocation

McLean, VA (Mar. 6, 2025) — A new story from The New York Times investigated the growing number of patients who are bypassed on organ transplant waitlists. In doing so, the story put a spotlight on systemic issues organ procurement organizations (OPOs) and transplant centers have been flagging to federal regulators for years.

Under regular protocols, every donated organ is matched and offered to compatible patients in ranked order. By federal regulations, OPOs have to pursue every opportunity to recover organs. However, not all organs recovered by OPOs are accepted by transplant centers, which are disincentivized from using medically complicated organs, such as ones from older or sicker donors. As The New York Times’ coverage noted, there are many reasons why transplant centers decline organs today, which puts increased pressure on OPOs to prevent organ non-use by using an emergency protocol called rescue pathway allocation.

Rescue pathway allocation – also known as expedited placement or out-of-sequence allocation – allow OPOs to offer recovered organs to transplant centers caring for patients who may be a good match for the organ, even if that involves bypassing patients who are listed higher on the waitlist. This is a carefully considered practice, addressed in federal policy, and used in specific, medically necessary circumstances to reduce organ non-use and increase the chances of successful transplantation.

Organ non-use has sharply increased in recent years due to the misalignment of policies within the system – specifically, requirements for OPOs to recover more organs while transplant centers adopt a more conservative approach to organ acceptance. As a result, more donated organs face the risk of non-use, leading to an increase in rescue pathway allocation to save lives.

In 2023 alone, 8,570 recovered kidneys went unused. Those same kidneys were offered by OPOs to transplant centers across the U.S. a total of 26,253,656 times before they became unviable. Government data shows that, as of December 31, 2024, each kidney saved through rescue pathway allocation had been declined by transplant centers over 200 times on average.

Every time a donated organ goes unused it is a double tragedy: families whose loved ones have generously donated their organs must be informed they were unable to save lives; meanwhile, patients who need life-saving transplants must continue waiting.

OPOs and transplant centers have called on the federal government – particularly the Health Resources and Services Administration (HRSA) – to reform misaligned policies that contribute to the rise of organ non-use and the subsequent increase in OPOs using rescue pathways.

HRSA has abdicated its responsibility to align the different parts of the organ donation and transplantation system to save more lives, particularly the sickest patients on the waiting list. Rather than being incentivized to work in tandem, OPOs and transplant centers have been forced to find their own solutions. Per The New York Times’ article: “Everyone is really trying to do the right thing.”

The story also highlighted that, in response to The New York Times’ investigation, HRSA finally called for solutions to the increase in OPOs using rescue pathways and the disparate policies that led to it. It is unfortunate it took media inquiries to get HRSA to act. This should be a wake-up call for the agency to begin adjusting its policies so transplant centers can accept organs more easily, thereby reducing the need for OPOs to resort to using rescue pathways to save lives.

OPOs work day and night to honor organ and tissue donors’ final wishes, support their grieving families and help as many patients as possible through the immeasurable gift of life that is organ donation. In 2024 alone, our commitment, in collaboration with our transplant partners, led to over 45,000 organs transplanted from deceased donation.

The Association of Organ Procurement Organizations urges HRSA to move quickly to save more lives. The Organ Procurement and Transplantation Network’s Expeditious Task Force was well on its way to finding solutions to organ non-use and rescue pathway allocation until the agency halted its work last year.

The U.S. organ donation and transplant system is the best in the world, but we can and must do better to ensure we honor the gifts entrusted to us.