Organ Donations

Stan, Clarence, Barry, and the Health Chatter team chat with Susan Mau Larson, Chief Administrative Officer at LifeSource, and Sarah Sonn, Director of Communications at LifeSource, about life saving organ donation.

Susan Mau Larson has spent her career leading strategic and policy efforts to strengthen organ donation systems nationwide and support donor families through the process. She has held leadership roles across national donation advocacy and public education organizations.

Sarah Sonn leads communications at LifeSource and focuses on public education, storytelling, and community partnerships to increase donor registration and address misinformation.

Join us for an insightful conversation about how every individual and institution plays a role in making life saving organ donations possible.

Find out more about LifeSource's life saving work here.

Join the conversation at healthchatterpodcast.com

Brought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.

More about their work can be found at https://www.huemanpartnershipalliance.org/

Research

• Quick Facts

• Last year, there were more than 48,000 transplants in the US, but more than 103,000 people were on waiting lists. 
• About 13 people in the United States die every day waiting for a transplant, according to the Health Resources and Services Administration.
• The majority of Americans—95% are in favor of organ donation. But only 58% are actually registered.
• less than 1% of donors end up meeting the specific medical criteria to donate their organs and tissue.
• Brief Overview of Organ transplant process 

1. Indication & Candidate Evaluation

• End‑stage organ failure: Transplantation is typically considered when native organ function (kidney, liver, heart, lung, etc.) fails and other therapies (e.g. dialysis, medical management) are no longer sufficient.
• Evaluation and listing: Patients undergo extensive medical, surgical, and psychosocial workups to assess suitability (e.g. comorbidities, infection risk, adherence). Those who pass are placed on a national (or regional) waiting list.

2. Donor Identification & Organ Recovery

• Deceased donors: Most organs come from individuals declared brain dead or, less commonly, donation after circulatory death (DCD). Consent is obtained via donor registry or next of kin.
• Living donors: For kidneys (or parts of liver, lung lobes) a healthy person may donate, subject to stringent screening to minimize donor risk.
• Organs are surgically removed under sterile conditions, flushed with preservation solution, and stored (often cold) to reduce metabolic demand during transport.

3. Matching & Allocation

• Compatibility: Matching involves blood type (ABO), human leukocyte antigen (HLA) or tissue typing, and crossmatch tests (to see if the recipient has preformed antibodies against donor antigens).
• Allocation policies: In the U.S., the Organ Procurement and Transplantation Network (OPTN), managed by UNOS (United Network for Organ Sharing), applies rules (the “Final Rule”) to distribute organs fairly across recipients.

4. Preservation & Transport

• Ischemia time: The period when the organ is without blood supply (“cold ischemia”) must be minimized to reduce tissue damage.
• Preservation techniques: Use of cold preservation solutions (e.g. UW solution) and sometimes machine perfusion (normothermic or hypothermic) to maintain organ viability.
• Innovations seek to shorten or eliminate ischemic injury (e.g. “beating heart” transplant techniques), though these are still emerging.

5. Implantation / Surgery

• Transplant procedure: In the recipient, the failed organ is removed (if applicable), vascular and ductal (e.g. biliary) connections made, and blood flow restored.
• Surgeons must minimize time, maintain hemodynamics, and ensure good perfusion of the graft.

6. Immunological Challenges & Rejection

• The immune system recognizes non‑self antigens on the graft and can mount rejection (hyperacute, acute, chronic).
• Monitoring for rejection is via biopsy, lab markers, or increasingly via molecular or biomarkers.

7. Post‑Transplant Care & Long-Term Management

• Immunosuppression maintenance: Lifelong therapy with periodic adjustments.
• Complication monitoring: Infections, cardiovascular disease, metabolic disease, graft dysfunction, malignancy.
• HHS moves to shut down major organ donation group in latest steps to reform nation’s transplant system
• In September 2025, the U.S. Department of Health and Human Services (HHS) announced its intention to decertify / shut down the Life Alliance Organ Recovery Agency, a division of the University of Miami’s health system, which is one of the nation’s 55 Organ Procurement Organizations (OPOs). 
• This marks the first time HHS (via CMS/HHS) has moved mid‑cycle to decertify an OPO — effectively pulling its contract to procure organs for transplantation.
• The move is part of a broader reform agenda being pushed by HHS and HRSA (Health Resources and Services Administration) to overhaul systemic problems in procurement, organ allocation, oversight, and public trust
• Per Kennedy: “Staffing shortfalls alone may have caused – it was a 65% staffing shortage consistently across the years – and may have caused as many as eight missed organ recoveries each week, roughly one life lost each day,” he said. “Our goal is clear: Every American must trust the nation’s organ procurement system. We will not stop until that goal is met.”
• Each year in the United States, more than 28,000 donated organs go unused and are discarded because of inefficiencies in the system, Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said Thursday.
• Mehmet Oz: “We’re going to be tougher than ever before, because if we lose trust in the organ transplantation system of this country, tens of thousands of people are going to die yearly whose lives could be saved,” he said.
• Public trust of the organ donation system is essential since the system relies on people to volunteer to donate their organs when they die. Most sign up when they’re getting their driver’s license.
• Other political complexities that are impacting organ transplants: Ethical, Regulatory, and Systems Context

• Organ allocation must balance fairness, utility, and justice. Policies exist to prevent trafficking or organ tourism
• In the U.S., the National Organ Transplant Act (1984) created the legal framework for organ procurement and distribution via OPTN/UNOS.
• The Uniform Anatomical Gift Act governs consent/donation laws at the state level.
• Algorithmic fairness in organ allocation is an active area of concern, especially as more metrics and machine models guide priority.
• System reforms are underway; for instance, in 2023, the U.S. began modernizing OPTN’s contract structure and introducing continuous distribution for multiple organs.

• Disparities in access and outcomes are documented: for instance, a scoping review found that patients from minority or low‐income backgrounds in the U.S. are less likely to be referred, listed, or receive transplants.
• Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. 

Sources

https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-024-01116-x

https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01616-x?

https://www.hhs.gov/press-room/hhs-decertifies-miami-organ-agency-reforms-transplant-system

https://www.cnn.com/2025/09/18/health/hhs-organ-donation-groups-crackdown

https://donatelife.net/donation/statistics/

https://optn.transplant.hrsa.gov/news/continued-increase-in-organ-donation-drives-new-records-in-2023-new-milestones-exceeded/ 

https://www.organdonor.gov/learn/organ-donation-statistics

https://www.donornetworkwest.org/about-donation/organ-donation-facts-statistics/