New law could allow big business to profit from organ donation

As the Biden administration looks to upend the nation’s organ donation system, I have a question — and the answer will impact millions of lives: should entities be allowed to profit from one person’s decision to give the literal gift of life to another?

On July 27, Congress passed legislation that, for the first time, allows for-profit companies control over our nation’s transplant system under contract with the federal government. The bill eliminates three rules that have been in place since the 1980s to make sure our system, built on the backs of people’s willingness to donate organs, is free from incentives to make money off their altruism:

1. Only non-profit entities may be awarded government contracts to run this system.
2. They must have expertise in organ donation and transplantation.
3. The annual funds awarded through these government contracts cannot exceed a specified upper limit, which is currently $7,000,000. The for-profit bill lifts that cap entirely.

With Congress’ passage of the bill and President Biden’s signature, for-profits will be eligible to run everything from the transplant patient waitlist to system policymaking that governs how the system operates nationwide. In short, it could lead to a for-profit donation system. The very term is a dangerous oxymoron with potentially fatal consequences for transplant patients, particularly patients of color who are at higher risk for developing organ failure — and have historically suffered most within profit-driven systems.

As a Black transplant surgeon with five decades of experience, I have spent my entire career fighting to improve the organ donation and transplant field in this country. I founded the National Minority Organ Tissue Transplant Education Program to increase transplant education and improve organ donation rates among minority communities. This work, which has been my lifelong passion, predates the system itself.

I also served on the Task Force on Organ Transplantation, which was established to guide the transplant system’s development after it was first formed by the National Organ Transplant Act enacted by Congress in 1984. We determined early on that the system must be led by non-profit interests, dedicated only to the needs of patients and with no concern for shareholders, market shares or profits. We made this clear to Congress in our 1986 Report of the Task Force on Organ Transplantation and they listened to us at the time. That’s why the rules, noted above, were established and why they have been in place ever since. Until now.

Given my deep concerns about a bill that opens the door to profiteering off of organ donation, I have connected with numerous colleagues about its dire consequences. We delivered a letter to 135 congressional offices calling for this legislation to be revised to restore the non-profit requirement for contracting with the government to operate the system. We aren’t alone: Over 26,000 patients, donors and concerned citizens also have caught wind of this development and are petitioning the federal government to prevent for-profit companies from running America’s Organ Procurement and Transplantation Network (OPTN).

Such an outcome will negatively impact both sides of what sadly becomes an equation. Under the current system, the non-profit entities responsible for recovering organs will go to any lengths to ensure donor and donor family wishes are carried out, regardless of costs. They operate under the principle that they owe this to donors, whose sacred gifts make the system possible in the first place.

I am a transplant surgeon, not a CFO, but it doesn’t require an MBA to envision that a system run by for-profits will shift focus from organ recovery at any cost to a cost-benefit analysis of every organ. Trust will erode, organ registration will go down, there will be fewer organs available, and fewer lives will be saved.

I see a place for for-profit companies within our massive and complex system, particularly for highly specialized fields to help the system as a whole improve efficiencies, such as IT. However, the laws, policies and practices that ensure equity for all Americans seeking transplant and seek the highest and best uses of their gifts must be free from profit motives.

My colleagues and I are fully supportive of system improvement and reforms to save more lives, but the current path we’re on will lead only to tragedy. I urge Congress and President Biden to reconsider whether their actions will truly lead to a better organ donation system than the one we already have. The federal government must engage in a dialogue with medical experts and thousands of others who are begging to be heard on this issue before condemning organ donation to a profit-driven future.

Clive O. Callender, M.D., FACS is a surgeon and professor of surgery at Howard University and founder of the National Minority Organ Tissue Transplant Education Program. As a member of the Task Force on Organ Transplantation, he helped guide the creation of the U.S. Organ Procurement and Transplantation Network and has since led efforts against discriminatory policies in organ donation.