How Bad Is Bureaucratic Incompetence? Deadly Mismanagement Of Organ Transplants Offers A Hint

Mary VoughtSeptember 8, 2022

If ever one program demonstrated the deadly consequences of an incompetent bureaucracy, our country’s system of organ donation and transplantation serves as the prototypical case.

A bipartisan report recently released by the Senate Finance Committee illustrates how the United States’ system of organ transplantation has harmed thousands of patients needing life-saving care, in far too many cases leading to individuals’ early demise.

The report provides devastating examples of how poor oversight plagues the nation’s 57 organ procurement organizations (OPOs). Each of these 57 OPOs serves a defined geographic area. Over several decades, not a single one has been decertified by the federal government as incapable of providing appropriate care to patients.

But the federal government’s failure to decertify OPOs does not mean they uniformly provide quality care to patients — far from it, in fact. The Finance Committee investigation found more than 1,100 complaints against the 57 OPOs during a 10-year period.

The cases examined by the Finance Committee show a staggering level of incompetence. The Committee recounted instances where patients died because they received organs with the wrong blood type — an obvious example of a “never event” that testing and clear communication should eliminate. In 53 other cases, patients submitted complaints regarding transportation issues, where delays by couriers and similar mix-ups meant that organs could not get transplanted in a timely manner.

Another complaint deserves quoting from the Finance Committee report directly: “On June 12, 2020, OPO staff accidentally threw a kidney in the trash after procurement, rendering it not sterile and therefore not usable.”

You read that right: A kidney did not get transplanted because staff threw it in the trash.

Worse yet, the Finance Committee found that virtually all complaints lodged against OPOs resulted in no disciplinary action. Of the 1,118 complaints examined, only 40 percent were referred to an internal professional standards committee.

And in only a single instance out of the 1,118 complaints received did the OPOs’ regulator take disciplinary action that would be revealed publicly, as opposed to giving the organization a private slap on the wrist or taking no action at all.

This degree of incompetence and corruption should be unacceptable at any level of government, much less one where lives are literally at stake. Every year, approximately 6,000 Americans die while waiting for an organ transplant, and a new person gets added to a waiting list for organ transplantation every nine minutes. Yet the organizations charged with increasing the number of transplants have lost organs in the mail and thrown organs into the garbage.

Thankfully, Washington has begun to take steps to fix this deadly mess. A package of rules released by President Trump, and later supported by the Biden administration, will begin bringing accountability to our nation’s dysfunctional system of organ transplantation. Organ procurement organizations will now get graded on how many organs they actually transplant into American patients.

These regulatory changes come not a moment too soon. Federal officials estimated that of the 57 OPOs currently operating, 22 would fail the tests laid out in the new rules. It should come as no surprise that estimates suggest these new rules will increase the number of organs transplanted by thousands each year.

But policymakers can and should go further. The Finance Committee report closed with suggestions that would open the nation’s organ transplant network up for additional competition and demanded oversight and accountability for harmful incidents — like organs being thrown in the trash — that heretofore has been largely lacking.

Improving our nation’s system of organ transplantation has become a bipartisan cause. The changes prompted by the Trump regulations can save patient lives while reducing the $36 billion in spending that Medicare currently pays to treat patients with kidney disease. I hope that the Finance Committee, other lawmakers in Congress, and the Biden administration continue to advance these important reforms because Americans’ lives hang in the balance.

Mary Vought is the founder of Vought Strategies. You can follow her on Twitter @MaryVought.