The stakes are literally life and death. More than 100,000 patients are on the national transplant list, awaiting organ transplants, with thousands needlessly dying before receiving them. For now, a single nonprofit, The United Network for Organ Sharing (UNOS), is the sole organization responsible for matching organ recipients with donors. Last year the 42,888 organ transplants performed were just not enough.
UNOS has been supervising organ donation and transplantation for four decades; it is the sole group that coordinates organ retrieval, set policies for distribution and prioritization, and run the massive computer system that matches organs with new patients. Generally, monopolies aren’t conducive to effective marketing, pricing, and product availability. But competition is not necessarily the solution, at least as far as consumer protection is concerned, although President Biden thinks it will be under his new plan for UNOS.
As a solution, President Biden intends to break up the monopoly, dividing the UNOS’ duties among multiple groups. The Health and Human Services Department announced it would accept bids for new contracts come fall, but the specifics have yet to be announced.
The current system has drawn complaints for multiple reasons, including long wait times and wasted donations. More than 30 peop
ole die unnecessarily daily while waiting for transplants - a dilemma disproportionately affecting Blacks.
According to a report by the National Academies of Sciences, Engineering and Medicine patients, “being older, having lower income, public insurance, more comorbidities, or being on dialysis at the time of kidney transplant evaluation” are often waitlisted while racial, logistical and regional inequities compound the problem
“Black people are four times more likely than white people to experience kidney failure. Latin people are one and a half times more likely to have kidney failure compared to white people. However, individuals in those demographics are less likely to even get on the waitlist for transplants. …
1 in 4 kidneys are actually discarded in the United States, and are not transplanted…. That’s 25%. And those are really lives that could have been saved if we could have utilized those organs.”
-Dr. Jayme Locke, Director Transplant Division, University of Alabama
Theoretically, UNOS supervises 56 Organ Procurement Organizations responsible for “recovering organs for transplant,” but the Senate Finance Committee, according to CNN, called their information technology system “outdated, mismanaged and insecure.”
The Biden Plan
The Administration plans to break up UNOS, increase funding by $67 million and increase transparency - although it’s not clear exactly how that will help. To this end, In this regard, the Health Resources and Services Administration launched a dashboard available online to share information surrounding organ donors and transplant wait lists.
The most potent aspect supposedly designed to remedy the problem is increased competition. Proponents claim more competition means more innovation.
”The announcement to break up the national organ monopoly is a huge win for patients,”
- Jennifer Erickson, senior fellow at the Federation of American Scientists
But evidence from a similar type of service, body donation, would indicate that competition is not the answer.
Organ donation (now run by UNOS) and body donation are not the same things, though it's a common source of confusion. Organ donation is highly regulated, providing organs to living recipients and is used to save lives. Body donation involves donating dead bodies for medical research, education, and training and is not nearly as regulated. There is no lack of donations, and expediency is not an issue. But that service (privately run and not ruled by any monopoly) is also plagued with problems.
So, what could be the problem?
As a recent case demonstrated, lots. The case of ALOIA v. GORE featured ten plaintiffs who sued the now-defunct Biological Research Center and its former owner for cutting up (or, to use the technical term “disarticulate”) the donated bodies and selling them on the black market all over the world. A jury returned a verdict of $58.9 million, including $50 million
At least four body donation companies operate in Arizona – no monopoly here - in addition to a nonprofit cryonics company that freezes people after they die with the intent of one day bringing them back to life.
Like many body donation companies (the “industry is worth about a billion dollars), Biological Resource Center picked up bodies after the person died, and returned the unused, cremated remains to families free of charge.
“Though the company asked people to "donate" their bodies after they died, the company was making money from the donation.”
Though the first case of its kind in the country, the plaintiff’s lawyer was confident this large award (upheld on appeal, although on technical grounds) would send a message to the body donation “industry.”
Competition does not seem to make a positive difference regarding body donation.
In the case of “disarticulating” UNOS and its organ donation program, it is hard to see what positive changes increased competition would accomplish. Organ donation has been simplified in the last few years by providing a check-off box to be a donor on applications for driver’s licenses. Several studies have shown that nudges, including asking whether the applicant would like a transplant if they needed one, increased checking off that box significantly.
In the case of body donation, the next of kin usually makes the “donation” While the deceased could direct this to be done in their will, enforcing this clause would be difficult. With no oversight or regulation,