Senate Investigation Exposes Failures at UNOS: What Needs to Change

When I read the Senate's findings on UNOS, I was furious — and then I was motivated. In August 2022, a bipartisan investigation by the U.S. Senate Finance Committee exposed deep systemic failures at the United Network for Organ Sharing (UNOS), the private nonprofit that has held the sole contract to manage the nation's organ transplant system since 1986. The findings were exactly what many of us suspected: thousands of viable organs were being discarded, inequities in allocation persisted along racial and geographic lines, and the organization was operating on decades-old technology. This is a policy problem, not a medical one.

Key Findings

The Senate investigation, led by Senators Ron Wyden and Chuck Grassley, found that UNOS had failed to modernize its data systems, with some components running on technology from the 1990s. The investigation documented cases where organs were lost in transit, where viable organs were discarded due to logistical failures, and where patients died waiting for organs that were available but never reached them.

"UNOS has operated as an unchecked monopoly for decades, and patients have paid the price with their lives." — Senator Ron Wyden, Chair of the Senate Finance Committee

The Scale of the Problem

According to data examined in the investigation, roughly 28,000 organs from deceased donors were not transplanted in 2021 alone. Let that sink in. While not all of these organs were necessarily viable, the report argued that thousands could have been used with better logistics, technology, and coordination. The investigation also highlighted that Black patients waited significantly longer for kidneys than white patients, and that geographic disparities meant a patient's zip code could determine their survival. Your zip code. In America. Determining whether you live or die.

Calls for Reform

The investigation catalyzed bipartisan momentum for reform. Senators introduced legislation to break up UNOS's monopoly and allow multiple organizations to manage different aspects of the transplant system — organ procurement, matching, logistics, and data management. The goal was to introduce competition and accountability into a system that had operated without either for nearly four decades.

"Every organ that goes to waste is a life that could have been saved. We owe it to the 100,000+ Americans on the waitlist to fix this broken system." — Senate Finance Committee report

YCOD's Perspective

Here's what I tell everyone at YCOD: fighting for opt-out legislation isn't enough if the system delivering those organs is broken. Increasing the number of registered donors through presumed consent will only save lives if the matching and delivery system actually works. That's why we advocate for both: more donors through opt-out laws like Bill A07954, and better outcomes through a completely reformed transplant network. You can't fix the organ shortage by blaming individuals — you have to fix the system.