Agency found lax in supervising organ transplant system
LOS ANGELES -- A little-known organization charged with ensuring safety and fairness in the nation's organ transplant system routinely fails to detect or correct problems at derelict hospitals, even when patients are dying at excessive rates, a Los Angeles Times investigation has found.
During the past year, the United Network for Organ Sharing, or UNOS, has been blindsided by life-threatening lapses at some of the centers it oversees.
When it does act, UNOS routinely keeps findings of its investigations secret, leaving patients and their families unaware of the potential risks, according to interviews and confidential records. Still, its penalties usually amount to little more than a wrist-slap.
"It seems like UNOS is often a day late and a dollar short," said Dr. Mark Fox, associate director of the Oklahoma
A series of problems at transplant centers in California have raised serious questions about the nation's regulatory system. The Times investigation found that UNOS's failure to act in those cases is part of a larger pattern.
Responsibility ultimately rests with the federal government. But since 1986, the government has contracted with UNOS to oversee everything from how organs are harvested to where they end up. Today, UNOS regulates 259 transplant centers and 58 regional groups that procure and distribute organs.
It is a daunting job. The competition for scarce organs is growing. And because the stakes are so high -- life, death, prestige, and millions of dollars for hospitals -- the temptations for transplant centers to bend or break the rules are ever-present.
UNOS has the power to issue public rebukes and urge the government to close troubled programs, but it has shown itself to be a reluctant enforcer. Often, the nonprofit organization has seemed more intent on protecting hospitals than patients.
Walter Graham, executive director for UNOS, described the troubles at California centers as a "watershed" for UNOS. The problems were "hurting public trust," Graham said. "There has been this escalating desire to stop that."
Within the past year, the UNOS board has voted to make some changes such as publicizing the names of centers that it puts on probation. Generally, however, resolving matters amicably serves patients better in the long run than issuing black marks, UNOS officials said.
A Times review of UNOS documents, as well as interviews with dozens of past and present board members, transplant doctors, patients and others, found that:
UNOS has never recommended that the government close an active transplant program. Since 2000, the organization has considered revoking the "good standing" of at least 15 transplant centers, but it has followed through just once.
Even after programs log high death rates, years sometimes pass before UNOS takes meaningful action, or even orders an inspection.
The organization often backs down after being challenged, or even defied, by medical centers that it is supposed to regulate.
UNOS officials have missed obvious red flags such as troubling transplant center statistics available on its website.
