U.S. Organ Donation System Fails Due to Unequal Access to Critical Care Units
A new study published in JAMA Network Open has exposed major gaps in the U.S. organ donation system. Researchers found that access to donor care units (DCUs)—specialised facilities for managing deceased donors after brain death—varies widely across the country. These disparities may be limiting life-saving transplant opportunities and creating inefficiencies in donor management.
As of the study period (2018–2023), only 34 DCUs were operational nationwide, though plans exist to expand this to 56. The findings highlight how geography, infrastructure, and policy are shaping unequal access to critical donor care.
The study identified operational hurdles that delay essential interventions for deceased donors. Without timely access to a DCU, organ viability can decline, reducing the number of successful transplants. These delays often stem from uneven distribution of facilities, with some regions lacking nearby units.
Transportation emerged as a key challenge. Moving donors across donation service areas (DSAs) to reach a DCU can introduce critical delays. Researchers suggested improving cross-boundary transfers and integrating telemedicine to monitor donors remotely, helping bridge geographic gaps. Expanding DCUs within acute care hospitals was proposed as another solution. This approach could reduce travel times and improve donor management quality, ultimately increasing the number of usable organs. The study also called for regulatory reforms to standardise DCU access and encourage cooperation between organ procurement organisations (OPOs). The research relied on a robust cohort design, analysing comprehensive datasets to support its recommendations. Its conclusions underscore the need for a coordinated effort—addressing policy, technology, and infrastructure—to create a fairer and more effective organ donation system.
The study's recommendations point to concrete steps for improving organ transplantation outcomes. Expanding DCU locations, refining transport logistics, and updating regulations could help close existing gaps. These changes aim to ensure equitable access to donor care and maximise the number of life-saving transplants across the U.S.
