Who will get the donation of kidneys, liver and hearts from the dead? For decades, the U.S. government has enforced strict rules (designed by doctors and ethicists) to ensure that they need their patients the most. The system should be fair.
More and more, this is not the case. Doctors in the United States transplant more than 40,000 organs from deceased donors each year, the largest in the world. In an increasing number of cases, officials skipped the top of the waiting list and sent organs to those who weren’t that sick and had no waiting time. These recipients have disproportionate whiteness and are better educated.
Last year, this happened nearly 20%, six times that of 2020. Some people have never undergone transplants and eventually die. I have been working with the Times reporter team to discover this problem and our story was published.
In today’s newsletter, I’ll explain why people at the front of the line don’t always receive the grafts they need.
“laugh at”
More than 100,000 people in the United States are waiting for transplants. But they are not all in one list. Instead, create a new list for each organ available – about 200 per day.
Here’s how it works: Each state has at least one nonprofit that restores organs and ranks all potential recipients nationwide using algorithms. Prioritize patients, wait longer and be nearby.
Nonprofits should follow a list when providing organs. But it may take time. The recipient’s doctor can refuse a quote for a number of reasons – the lungs may be too big, the donor is too big, the patient is too far from the hospital. Meanwhile, the clock is ticking. Organs can only last for so long in the body.
So sometimes, officials have an exception: If an organ is at risk of being unusable, they ignore the ranking and simply choose a hospital to occupy the organ to ensure donations are not wasted. This happens about 2% of the time over decades.
But in 2020, government regulators began to put pressure on nonprofits to throw away fewer organs. In response, these tissues began to skip patients more frequently.
Nonprofits describe the tension between what they should do (place as many organs as possible) and what hospitals often do (rejecting organs they think are not matched to the patient). The head of the nonprofit trade group told us that skipping is necessary, even if it is an imperfect solution. They said they ignored the list to save lives and place organs that could be destroyed.
But our report finds that they do this often—even with enough time for high-quality organs. We found that they bypassed patients because it was easier to turn the organs to the hospitals that they had to do with.
These hospitals are free to choose which patients receive organs, regardless of where they are on the waiting list. They are motivated to choose healthier recipients because they can judge based on how many patients are identifiable after the surgery.
People throughout the transplant network were shocked by these practices. “They are laughing at the distribution system,” said Dr. Sumit Mohan, a kidney expert at Columbia University. “It’s shocking. It will undermine trust in the system.”
Who is alive and who is dead?
Since 2004, we have analyzed over 500,000 organ transplants and found that ignoring the cohort does not prevent waste. In fact, the speed of abandoning organs has increased.
This approach means that blacks and Latinos are treated worse. Data show that grafts disproportionately go to white and Asian patients as well as those with college degrees when nonprofits and hospitals ignore the cohort.
Over the past five years, we have found that over 1,200 people died after approaching the top of the waiting list but were skipped. Their doctor may decide that the organ is not suitable for them, but they never have the chance to find out.
Patients rarely learn that they have been skipped. They just didn’t get calls that could mean the difference between life and death.
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