About 1 in 5 donated organs goes unused as hospital criteria diverge
Katherine Screws received a new intestine at MedStar Georgetown University Hospital in Washington in June 2025, weeks after she registered at a second transplant center. The Phoenix woman had waited three years since a May 2022 car crash destroyed her small intestine, though her first hospital initially predicted that a transplant could come in about six months. It could have been longer without the unusual meeting with OneLegacy, which taught the frustrated Screws how hospitals vary in which organs they accept or refuse. She flew across the country for a better chance. Screws learned the donated intestine came from a donor in Chicago and was longer than is usually transplanted; Dr. Cal Matsumoto said it fit well. Her experience highlights a transplant system that often struggles to inform patients about options that can be difficult to navigate on their own.
Before the crash, Screws described herself as a passionate foodie who loved to cook. The crash occurred a month after her wedding and required removal of the organ that breaks down food and absorbs nutrients. The loss left her unable to eat, dependent on overnight IV nutrition and often too sick to get out of bed. Severe nausea prevented her from returning to her engineering job or pursuing plans with her husband to start a family. In late 2024, organ procurement organizations, or OPOs, around the country began receiving emotional letters from Screws and some family members describing those consequences.
Screws wrote that “This accident completely derailed my life and the wait for a new organ has been excruciating,” adding that her original transplant doctors “feel that it is possible there is a lack of awareness of small bowel transplant among organ procurement organizations.” She asked OPOs to “confirm your organization’s matching programs are properly searching for and prioritizing small intestine donations.” Screws also said, “I wish that there was more clarity with patients about when is an organ coming up that could be a match for you and why is it not a match,” and she wishes she had asked sooner, “What is the thing that’s holding this up?”
OPOs are required to recover as many organs as possible, and Screws’ question was shocking to them. They act as a bridge between donors and transplant hospitals, work closely with grieving relatives of deceased donors, and seldom hear questions from would-be recipients. Lisa Stocks, a nurse with California’s OneLegacy, one of the nation’s largest OPOs, realized its records could help patients advocate for themselves and began combing through them. OneLegacy made nine offers for Screws during 2024, all rejected. Stocks had “candid conversations” with Screws’s transplant team about technical preferences in organ retrieval so she could better evaluate potential donors, then showed Screws the Scientific Registry of Transplant Recipients database so she could identify hospitals that perform more intestine transplants.
Patients may not know where to seek care, whether to join multiple hospitals’ transplant lists or whether they would accept a less-than-perfect organ rather than continue waiting. Dr. Allyson Hart of Minnesota’s Hennepin Healthcare Research Institute helped design tools for a new patient-friendly online database that compares waiting times and other characteristics of transplant centers. Hart said most patients do not know what to ask. Too many patients think “they just needed to wait for five years and they would get transplanted,” Hart said, when often “that’s actually not what happens.”
Dr. Syed Ali Husain of NYU Langone Health, who researches differences among transplant centers, said a large study found “there’s about a 16-fold variation in how quickly a patient will get transplanted at one center versus another.” He said one reason is that some surgeons have more experience than others using kidneys with complex anatomy, including extra arteries, or kidneys from older, sicker donors that may still be better than dialysis for the right patient.
Far less information is available for rare transplants such as the intestine, which is biologically more difficult to handle than some other organs. Screws was one of just 88 people in the U.S. to receive a new intestine last year, compared with more than 27,000 kidney transplants. Lisa Stocks said, “We offer them but they’re declined so often that it’s demoralizing.” About 1 in 5 donated organs go unused, usually because a recipient is not found in time.
Just over 49,000 transplants were performed in the U.S. last year, more than ever, largely because donations from deceased donors increased for more than a decade, with OPOs recovering the organs. About 100,000 people were awaiting a transplant, and the vast majority needed a kidney. Growing pressure to retrieve and use more donated organs has coincided with a recent dip in donor registrations; an aging population means organs increasingly come from older, sicker donors. The government is also in the midst of a yearslong overhaul of the transplant system.
A pending regulatory move could close some of the nation’s 55 OPOs under a grading system that considers both the number of organs procured and how many are transplanted. OPOs argue that the second measure is largely outside their control because surgeons decide whether an organ is right for a patient. OneLegacy and other OPOs are part of lawsuits seeking to block the closures. Regulators also grade hospitals, and Husain said some of the reluctance to use less-than-perfect organs has long stemmed from concern about getting a lower score if even a few of them fail. Medicare is running a pilot project to see if financial incentives or penalties will push hospitals to perform more kidney transplants, so fewer of those donated organs go to waste.
Every transplant center maintains its own organ-specific waiting list, linked to a nationwide automated matching system. The OPO handling each deceased donor enters information about organs deemed suitable for use, generating priority lists of potential matches at multiple hospitals. A patient can meet baseline biological requirements and still not appear because a surgeon has added preferences, such as requiring a donor younger than 40. Transplant teams then must decide quickly on an offer using lab tests, scans and other medical records; if they decline, the organ is offered to the hospital with the next possible match.
Matching begins before surgery to recover the organs, and distance also plays a role, as some organs last longer than others outside the body. Oftentimes, surgeons travel to personally remove certain tricky-to-handle organs rather than relying on a local surgeon to retrieve and ship them. Matsumoto said a good donor generally brings together heart, lung, pancreas and liver teams to coordinate recovery. For an intestine, he said, surgeons also negotiate how to divide critical blood vessels shared with nearby abdominal organs. “It’s the right donor at the right time. You can never predict these things,” Matsumoto said.
A study published last year examined kidney patients who died on the waiting list and found a median of 25 organ offers their transplant teams had declined. Those organs were eventually used in someone else.
UCLA Health, Screws’s original hospital, cited patient-privacy rules in declining to comment except to say that it follows federal transplant guidelines and that its transplant teams “continuously strive to enhance processes in service to our patients.” Although its intestine program is small, UCLA is a major provider of kidney and other transplants. Screws said her frustration was not with her doctors but with the lack of centralized, easy-to-understand information. She had not heard of OPOs until a transplant coordinator mentioned them, she said, when she realized there had to be a bridge between donors and transplant surgeons. Screws said, “My main takeaway was that there is more subjectivity to selecting an organ than I would have previously thought.” Her intestine was “larger than average and maybe another surgeon wouldn’t have accepted that.”