UNOS has replied to your article by collaborating with the NYT on a hit piece on a transplant surgeon who, to my eyes, was likely getting around issues with their software by either holding slots for currently ineligible patients on the list by setting invalid match criteria, switching patients between ineligible/eligible by setting invalid/valid match criteria, or some other random issue which I can't discern.

People searching for UNOS will now hear from their ethics officer complaining about this particular surgeon's practices and an article implying the surgeon, whose hospital allegedly had a disproportionate (no numbers cited for base rate, not enough numbers cited to calculate a hospital rate) number of deaths on the transplant list, is a killer - as if the best way a transplant surgeon could kill someone is to edit numbers in their own name in a widely accessible national database. They will not hear about the many different exclusion criteria for transplants, nor any of the issues with UNOS that you've identified here.

You're clearly over the target!

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The fundamental solution here is to allow a market for organs to operate. Rationing always creates such inefficiencies.

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There is a long reply in Marginal Revolution which shows this whole piece to be largely wrong. High rates of unused organs reflects aggressive harvesting. Deceased patients being offered organs reflects high mortality rate on waiting lists. And so on. As far as monopoly goes, unclear what the alternative is. Competing teams asking for donations? I agree there should be a split between boards. And routine external review. Which for all I know already happens. Beyond that, there doesn’t seem to be much here. At least they don’t make a good case.

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This is an amazing story. Some of this I knew, some of it I didn’t; much of the latter related to just how dysfunctional the US healthcare system is.

I’m surprised, though, by this passage:

"That OPO is supposed to turn up to every potential case in a timely and compassionate way and have one of two conversations with the family... Keep in mind that 95% of Americans support organ donation. My older brother is a registered organ donor, and if, God forbid, something happened to him, and someone approached me at the hospital in a timely and compassionate way, I would consent to organ donation. If they do not approach me, then I cannot consent."

The implication seems to suggest that, if only an OPO spoke to them compassionately, a huge proportion of families would consent to the removal of their loved one’s organs.

But European experience, even in countries with really great infrastructure for having those conversations, is that a not-insignificant proportion of families refuse consent for donation when approached. I’ve heard numbers in the 30%-50% range for family refusal in the UK, the country I know the most about. I had vaguely thought rates were similar in the US, but I'm aware I've never poked at the definition of "family consent withheld" etc. in US stats, so maybe those numbers include cases where the conversation never happens.

This is, however, a small quibble with an otherwise very good post. (Certainly, no matter whether families might not consent if the conversation takes place, they cannot consent if it doesn’t!)

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I think that, about someone needing to come to you in a compassionate matter is what would trigger you to consent to having your family member donate their organs if they pass why can’t you be proactive and go to someone in a compassionate yourself and say hey, my brother brother-in-law is a registered Oregon donor. Can we talk about this? Why would someone need to approach you?

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This is a problem that never even entered my mind, we think something so important like this couldn't have that much negligence, but I guess we shouldn't be surprised.

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