Q: How are you working to improve the nation’s organ procurement system?

A: Nearly two decades ago, I started looking under the hood of the system Congress created in 1984 to regulate the nation’s organ procurement system with passage of the National Organ Transplant Act. That federal law provided the framework for the national organ donation, recovery and transplant system. My initial investigation looked into the U.S. Organ Procurement and Transplantation Network (OPTN) after numerous inspector general audits and news reports raised questions about the inadequacy of patient safety standards and improper use of Medicare dollars, and suggested that thousands of available organs were not being used. Since 1986, the United Network for Organ Sharing (UNOS) has contracted with the federal government to manage the U.S. organ donation system, including overseeing the Organ Procurement Organizations (OPOs) that operate across the United States, recovering organs from generous American donors. Currently, 56 regional OPOs effectively function as regional monopolies, each assigned a specific geographic zone. Despite the generosity of American donor families and lives saved over the last four decades, the system has become riddled with flaws. That’s why I’m leading efforts to strengthen and modernize the ecosystem that manages the scarce pool of donor organs — compared to the much larger pool of patients on the waiting lists — so that it operates more effectively and efficiently. Throughout my oversight work in Congress I’ve found that transparency brings accountability. Since drilling down into this health care space, I’ve uncovered lax oversight and recurring failures by federal contractors, from substandard patient safety, to mismanaged organ procurement, botched system outages in information technology, squandered resources, and questionable organ procurement procedures to boost performance metrics.

My bipartisan investigation with Sen. Ron Wyden of Oregon has exposed serious shortcomings with the status quo and identified preventable mistakes with deadly consequences. Gaps in oversight, conflicts of interest, inadequate patient safety, outdated technology and mismanaged taxpayer money undermine public confidence and put lives at risk. I’ve reached an indisputable conclusion that reforms are needed to improve the recovery rate of potential donors; curb mismanagement of unrecovered, lost or damaged organs; stop bad actors from fleecing taxpayer dollars; and, save more lives. Mounting evidence from independent audits further underscores the urgency for solutions. It’s a matter of fairness to donor families, patients waiting for transplants and taxpayers. Waiting to be notified of a match puts gravely ill Americans and their loved ones on an emotional roller coaster. And donor families are making selfless decisions to help strangers in need, often on the worst days of their lives. We must do better to restore the integrity of the nation’s organ procurement and transplant system to help ensure the precious gift of life isn’t snuffed out due to mismanagement, corruption and abusive practices. Tightening oversight, boosting transparency and bringing competition to bear are tools we can use to help save lives, improve patient safety and stretch taxpayer dollars. In March 2023, the U.S. Department of Health and Human Services made clear that it finally has learned from our Senate investigation, and pledged reforms to break up the national monopoly organ procurement transplantation network contract that has mismanaged the U.S. organ donation system for years.

Q: Why is National Donate Life month important?

A: First, I salute the legions of health care providers, medical scientists, organ donors and their families who have helped to save the lives of hundreds of thousands of Americans since the first organ transplant in 1954 here in the United States. We have work to do to make our system even better. With much-needed reforms on the table, policymakers must work together to fix what’s broken and ensure the miracles of modern medicine continue to push forward to save more lives and improve the quality of life for Americans of all ages for generations to come. Celebrating its 20th year of observance, April is recognized as National Donate Life month to help raise awareness about organ, eye and tissue donation and to honor those whose generosity has given recipients a new lease on life. Last year, more than 42,000 transplant surgeries were performed in the U.S. Those who have answered the call to donate are true heroes among us, including living donors who may donate one of their own kidneys, or a segment of their liver, pancreas, or lobe of a single lung to give a loved one, neighbor or total stranger a second chance. More than 1.6 million Iowans are among the 170 million people in the U.S. who are registered as organ, tissue and eye donors. And still, 17 people in America die each day waiting for an organ transplant and 104,234 men, women and children currently are on the national transplant waiting list. During the 118th Congress, I’ll continue my efforts to make the nation’s organ procurement and transplantation system the best in the world.

April is Donate Life Month. Iowans may sign up to become a donor at the state’s registry Iowa Donor Network at www.IowaDonorNetwork.org, or call (800) 831–4131