For years, the nonprofit groups that coordinate transplants in the United States regularly ignored federal rules — skipping patients at the top of waiting lists and sending organs to those who weren’t as sick and hadn’t waited as long.
But new federal data shows that the rate of skipped patients has dropped by more than half in recent months, a change that reflects a far-reaching effort to make the transplant system fairer and safer.
“This is truly great news for patients and the system,” said Dr. Jesse Roach of the National Kidney Foundation. “We need to continue to monitor it, to ensure the system is fair, efficient and transparent. But this is a win.”
The shift comes after The New York Times reported last year on widespread problems in the organ donation system, including a sharp increase in bypassing patients on waiting lists.
The nonprofits — known as organ procurement organizations, which have contracts to arrange transplants in each state — said at the time that they were skipping patients only to place organs that were at risk of deteriorating and not being used. But The Times found they often did it to save time and money and steer organs to favored hospitals.
Since then, federal health officials have begun tracking the practice and publishing data online. The rate of skipped patients fell from nearly 20 percent of transplants in 2024 to about 9 percent in recent months. Officials have also promised to strengthen the rules to stop the practice.
The latest data showed that the drop had not led to more organs being wasted. In fact, organ usage has increased.
The changes are part of a broad crackdown spurred by The Times’s reporting as well as pressure from Democrats and Republicans in Congress.
After months of deliberations, the board that oversees the transplant system is poised to approve a set of policies addressing the safety of an increasingly common practice known as “donation after circulatory death.”
Unlike most donors, who are brain-dead, these donors have some brain activity. But they are on life support, often in a coma, and doctors have determined that they will never recover. If donation is authorized, doctors withdraw support, wait for the heart to stop and then remove the organs.
The Times reported last year that a push for more transplants had led to a growing number of rushed cases in which patients endured premature or bungled attempts to retrieve organs. Some potential donors were gasping, crying or showing other signs of life. In Alabama, surgeons cut into a woman before discovering she was alive. Federal investigations found additional cases, including dozens of instances in which the Kentucky procurement organization ignored signs of increasing alertness in patients.
The Association of Organ Procurement Organizations, a national trade group, has emphasized that safety errors are rare.
The proposed rules would require all potential circulatory death donors to undergo frequent neurological testing to ensure they are not regaining consciousness. It would also empower health workers and family members to pause the process.
Emily Hilliard, the press secretary for the U.S. Department of Health and Human Services, said in a statement that the “reforms are essential to restoring trust, ensuring informed consent and protecting the rights of prospective donors and their families, as all donors deserve to have their life honored with dignity.”
Last year, the department closed a procurement organization highlighted by The Times and ordered all groups to hire patient safety officers. The health secretary, Robert F. Kennedy Jr., has said he is continuing to investigate the system.
Congress is also investigating. Three congressional committees have held hearings on donor safety in recent months.
“For too long the system has fallen short for the thousands of families waiting for a lifesaving transplant, as well as the communities and donors that expect more when they agree to help save a life,” said Senator Ron Wyden of Oregon, a Democrat who has drafted legislation to increase monitoring of donor safety.
The House Ways and Means Committee, which warned in November about problems at the New Jersey procurement organization, recently began examining another issue reported by The Times — how despite America’s organ shortage, some hospitals have catered to overseas patients who pay more for transplants.
“It is reprehensible that it now appears U.S. hospitals, especially those who enjoy tax-exempt status, have acted as concierge organ clinics, bypassing American patients for wealthy foreign nationals willing to pay to skip the line,” said Representative Jason Smith of Missouri, the committee’s Republican chairman.
Federal health officials have asked the Justice Department to investigate one of the cases reported by The Times, involving a Japanese patient who received a heart transplant at the University of Chicago within days of coming to the United States. Soon after, a charity run by the patient’s husband donated to a spiritual organization led by the transplant surgeon’s wife.
None of the parties involved returned messages seeking comment. Some hospitals have described transplants for international patients as humanitarian efforts and denied giving the recipients preferential treatment.
Transplant system officials are investigating several hospitals that serve international patients and have created a working group to study policy changes.
Hospitals and organ procurement organizations have acknowledged the need for reforms but argued that focusing too much on problems could hamper organ donations. Last summer, amid the focus on safety issues, the nonprofit Donate Life America reported that at least 20,000 people had removed their names as registered donors. There were about 174 million donor registrations at the time.
This week, a spokeswoman for Donate Life America said it did not have more up-to-date data.
Procurement organizations reported a slight reduction in the number of retrieved organs last year, but U.S. hospitals nevertheless did more transplants than ever — over 49,000.
Dr. Seth Karp, a transplant surgeon at Vanderbilt University who has testified at congressional hearings about problems in the transplant system, said he was encouraged by the flurry of changes.
“We’re going in the right direction,” Dr. Karp said. “Change is hard, but it’s sometimes necessary. I really believe that we are making the system stronger.”
Brian M. Rosenthal is an investigative reporter who has worked at The Times since 2017.
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