Acting under guidance from HHS, the Health Resources and Services Administration (HRSA) has contracted with the United Network of Organ Sharing (UNOS) since 1986 to match organ donations with those needing transplants. Over the last decade some within UNOS have pushed on and off to change the way organs are allocated to a regional, not local, system – despite significant opposition from the medical community, a large number of individual states, and many on Capitol Hill. Indeed, on February 2, 2009, just days after the inauguration of President Obama and without an HHS Secretary in place, UNOS made an aggressive move to advance a proposal that would result in regional distribution of livers. UNOS Regions commenced voting on the proposal a mere three weeks later and public comments were due the end of April.

WHAT WE HAVE DONE: UNOS solicited public comments due April 24, 2009. With the efforts of NOTAC members through various grassroots campaigns in addition to NOTAC Congressional outreach, we were successful in stimulating an outpouring of negative comments to the proposals.

Status 1 proposal (regional allocation for terminally ill patients):
• Of the 337 comments submitted:
  • 88 (26.11%) supported the proposal,
  • 238 (70.62%) opposed the proposal, and
  • 11 (3.26%) had no opinion.

MELD (regional allocation for all other liver transplant patients):
• Of the 1,865 comments submitted:
  • 158 (8.47%) supported the proposal,
  • 1,697 (90.99%) opposed the proposal, and
  • 10 (0.54%) had no opinion.

The Status 1 proposal was presented to the UNOS Board of Directors on June 24, 2009 and approved. Due to the public response, action on the MELD proposal has been delayed until after a public forum, scheduled to be held spring 2010. Final action on these proposals, and any proposal changing the allocation process, will need to be approved or denied by the still to be confirmed head of HHS.