To: Organ transplant candidates and recipients
From: Sue V. McDiarmid, M.D., UNOS and OPTN President
October 24, 2006
As President of the United Network for Organ Sharing (UNOS), which operates the nation’s Organ Procurement and Transplant Network (OPTN) under federal contract, I want to assure you, in both strong and detailed terms, of the vigilance we apply to ensure the safety of patients awaiting transplantation in this country. Most particularly, my comments are directed to those of you who may feel disturbed and anxious by recent newspaper reports regarding oversight of the national transplant network.
First it is important to understand the extent of the routine evaluations UNOS makes of everyone of the 920 transplant programs in the United States. As required by the Department of Health and Human Services, with whom we contract to operate the OPTN, UNOS collects information on every listed and transplanted patient in this country. We assess every six monthsevery program’s performance and compare it to expected national outcomes. This information is publicly available on a website, As well, our routine reviews of all programs include but are not limited to:
- on-site audits every three years,
- evaluation of transplant program activity,
- assessment of every donor organ placement,
- investigation of donor organ allocation rule violations,
- review of every application for changes in key medical personnel at established programs, and
- an extensive application process for new programs.
Most programs perform well and comply with the rules and policies that govern transplantation in this country. However, wheneverpotential problems are identified, the program is contacted by letter and often by UNOS staff in person, to ask for additional information and explanations for the discrepancies observed.
The OPTN/UNOS Membership and Professional Standards Committee is responsible for investigating issues of policy compliance, quality of care and patient safety. In the past year, this committee investigated 308 programs with lower than expected outcomeson routine reviews, 39 programs with low activity, and 109 programs for possible adverse actions.The great majority who have had identified problems, responded with improvements that allowed them to improve their performances and provide better service to their patients.However, since 2000, 115 programs chose to inactivate or voluntarily close, when it became clear that they could not meet the standards for improvement required by UNOS.
It is important that you understand how we proceed when a transplant program is identified for a review. We do not have the choice of ‘act first, ask later’. The reason is compelling. For every action taken against the transplant program that may threaten their operation, we put into jeopardy patients on that program’s waiting list.
As you are so well aware, patients depend on the operation of their program to receive a life-saving organ. The overriding ethical challenge we have faced over the years, has been how to balance the safety and access to transplantation of patients on a program’s waiting list, against disciplinary actions which jeopardize the program’s activity. Unless we have been able to identify an imminentdanger to patients on a waiting list of a program under scrutiny, we have felt it was incumbent upon us to work diligently to correct a program’s behaviors rather than to forcetheir closure.
Unfortunately, it is also clear that there are a few transplant programs that have engaged in practices that defy any standards of acceptable conduct. The transplant community, patients and physicians alike, are dismayed when such egregious behaviors are exposed, despite our best efforts to avoid such circumstances. We are fully aware of the anxiety and vulnerability that every patient on a waiting list feels every day that they wait. UNOS remains steadfast in its resolve to improve our practices that ensure your protection.