Every year, hundreds of Kansans and Missourians receive devastating medical diagnoses and, in some circumstances, their only life-saving treatment is a liver transplant. Currently, nearly 240 residents from both states are on a national waiting list to receive a donated liver.
But as weeks go by, Kansas and Missouri names are rarely called. This is because the entire system to allocate donated livers is rigged against Americans who live in the Midwest.
Developed in 2018 by the United Network for Organ Sharing (UNOS), the new liver allocation policy intentionally colluded against Midwest and Southern states. As Senators of Kansas and Missouri, we have repeatedly expressed outrage with this organ allocation policy.
UNOS is a private organization contracted with the U.S. Department of Health and Human Services (HHS) to oversee the national organ transplantation system. UNOS changed the liver allocation policy by adjusting the geographic parameters guiding which patients received donated organs, even if the patients were located hundreds of miles away from donors. The decision four years ago punished patients in the Midwest and the South the regions with the highest rates of organ donors by sending more organs to coastal urban areas.
The process itself was fraught with major flaws. UNOS overruled the Liver and Intestine Committee, whose members are some of the nation’s leading transplant experts; excluded certain public comments in the deliberations, including those from the University of Kansas; and arrived at an outcome that was significantly different from the previous standard.
Based on these actions alone, it was clear the process was unfair. In addition to concerns raised by Congress, more than a dozen transplant hospitals have taken HHS to federal court to overturn the allocation changes for three different organs liver, lungs and kidneys.
As a result of the litigation, a November 2021 ruling by the United States Court of Appeals for the Eleventh Circuit required the public release of emails from UNOS and they were shocking. The hundreds of pages of internal communications revealed clear collusion between UNOS, a New England-area organ procurement organization, and others as they crafted the new liver allocation policy. One conversation, authored by the president and CEO of the New England organization sent to the head of UNOS, said, “You’re a dumb (expletive) for living” in the South and health professional shortage areas.
These emails show without a shadow of a doubt the liver allocation decision was fundamentally flawed from the beginning, and the body charged with supervising it is systematically broken. Americans in the Midwest and the South have every right to be fairly considered for an organ donation. Discrimination based on the region a patient chooses to live should not be a factor in deciding who receives a lifesaving organ. In health care, life and death decisions are a sad but unfortunate reality, but a patient’s choice to reside in a rural community should not be a factor in America’s national liver allocation system.
The UNOS emails provide the most concrete evidence yet of a fundamentally unjust policy, but concerns brought to HHS have been disregarded at every turn. In the aftermath of public access to these emails, HHS Secretary Xavier Becerra should have immediately reviewed and reversed the allocation policy. Secretary Becerra has a duty to uphold the mission of his agency to “enhance and protect the well-being of all Americans.”
All Americans include those who decide to live in the Midwest and the South. HHS cannot continue upholding a policy that blatantly pits regions of the country against each other punishing states with stronger organ donor networks and results in prolonged wait periods, increased costs and system inefficiencies. Furthermore, fulfilling the agency mission at even the most basic level would mean reversing a policy created by individuals with a documented disdain for Americans outside the Northeast and Northwest.
It is unconscionable for HHS to willingly ignore the overwhelming evidence and continue implementing the liver allocation policy.
When an American is facing a life-or-death transplant diagnosis, each one deserves to know the system charged with providing organs is just, no matter where you live or who you are. We are again urging Secretary Becerra and HHS to reverse this biased and unjust allocation policy. The lives of our family and friends depend upon it.
• U.S. Senator Jerry Moran of Kansas serves as lead Republican on the Appropriations Subcommittee on Commerce, Justice, Science, and Related Agencies. He is also the lead Republican on the Senate Veterans’ Affairs Committee and a member of the Health, Education, Labor, and Pensions Committee. His focus on protecting rural Kansans and their communities led him to co-found the Senate Community Pharmacy Caucus, the Senate Economic Mobility Caucus and the Senate Hunger Caucus. U.S. Senator Roy Blunt of Missouri serves as the Chairman of the Senate Republican Policy Committee and as the Ranking Member of the Senate Rules Committee. He also serves on the Senate Appropriations Committee; the Senate Commerce, Science and Transportation Committee; and the Senate Select Committee on Intelligence. He is also the Ranking Member of the Appropriations Subcommittee on Labor, Health and Human Services, and Education. In the House, he was elected the Majority Whip earlier in his career than any Member of Congress in eight decades, and he was elected to the Senate leadership during his first year in the Senate.