Following passage of the Securing the U.S. Organ Procurement and Transplantation Network (OPTN) Act, which empowers the Health Resources Services Administration (HRSA) to break up the national organ monopoly contract, the Energy & Commerce Committee launched a bipartisan investigation into both the law’s implementation, and the failures of the current OPTN contractor, the United Network for Organ Sharing (UNOS). Committee leaders wrote: “UNOS has been the sole organization managing the OPTN, during which time concerning reports have emerged that the organ donation system has become unsafe, inequitable, self-dealing, and retaliatory.” Timeline below. September 2024: The House Energy & Commerce Commerce held “Oversight Hearing on Organ Procurement and Transplantation Network. Watch the hearing here, and see Wall Street Journal. March 2024: Bipartisan leaders issued oversight to both UNOS and the Health Resources Services Administration (HRSA), the federal agency which oversees the OPTN contract. The inquiry is led by Chair Cathy McMorris Rodgers (R-WA) and Ranking Member Frank Pallone, Jr. (D-NJ); Subcommittee on Health Chair Brett Guthrie (R-KY) and Ranking Member Anna G. Eshoo (D-CA); and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA) and Ranking Member Kathy Castor (D-FL). See ABC News.

The Senate Finance Committee is more than four years into a bipartisan investigation into deadly failures of both the United Network for Organ Sharing (UNOS), which holds the national monopoly contract to manage the U.S. organ donation system (known as the Organ Procurement and Transplantation Network OPTN), as well as the local organ procurement organizations (OPOs) it is supposed to oversee. Timeline below. March 2025: Senators Grassley and Wyden write to HRSA and CMS about OPOs systemically and inappropriatley skipping non-white patients on the waiting list in order to financially benefit preferred hospitals. See Healthcare Dive. August 2024: Senators Wyden and Grassley write to UNOS, HRSA, and the White House Office of Management and Budget (OMB) respectively regarding potential ethics violations related to UNOS’s hiring of Ankit Mathur. See Bloomberg. June 2024: Senators Wyden, Grassley, Young, Cardin write to the Centers for Medicare and Medicaid Services (CMS) “to Strengthen Protections Against Excessive and Unnecessary Recoveries of Pancreata from Organ Donors” June 2024: Senators Wyden, Grassley, Young, Warren, and Moran write to the leadership of the OPTN to correct industry misinformation about HRSA’s OPTN Modernization Initiative May 2024: Senators Wyden, Grassley, Young, Warren, and Moran write to the Health Resources and Services Administration (HRSA) about Requests for Proposals (RFPs) for OPTN contracts. March 2024: Senators Wyden and Grassley write to UNOS regarding “Data Breach That Exposed Organ Transplant Patients’ Sensitive Data”. See Richmond Times Dispatch. September 2023: Senators Wyden, Grassley, Cardin, Young, and Cassidy celebrate President Biden signing into law bipartisan legislation to break up the OPTN monopoly contract. See CBS. September 2023: Senators Wyden, Grassley, Cardin, and Young send oversight letters to 8 OPOs into “Potential Self-Dealing And Financial Conflicts Of Interest” as well as to the Centers for Medicare and Medicaid Services (CMS) regarding the need for regulatory reforms to OPO reimbursement structures. July 2023: The Senate — led by the Senate Finance Committee — unanimously passes legislation to break up the OPTN monopoly contract, following unanimous passage of the same legislation by the House of Representatives. July 2023: Senate Finance Committee holds bipartisan hearing into UNOS failures and whistleblower retaliation. March 2023: Senators Wyden, Grassley, Cardin, and Young send oversight letters to 10 OPOs regarding the practice of harvesting human pancreases to exploit a regulatory loophole. See Washington Post. March 2023: Senators Wyden and Grassley write to UNOS about technology outages. November 2022: Senators Wyden, Grassley, Cardin, and Young write to the National Academies of Science, Engineering, and Medicine (NASEM), raising conflict of interest concerns related to the NASEM organ donation report. November 2022: Senator Booker and Rep Mondaire Jones lead a bicameral letter to HHS with other Members of the Congressional Black Caucus endorsing the Senate Finance Committee’s recommendations. August 2022: Senate Finance holds a bipartisan hearing and releases a bipartisan report, concluding “from the top down, the U.S. transplant system is not working, ​​putting Americans’ lives at risk.” See front-page Washington Post stories on UNOS tech failures and on UNOS/OPO patient safety failures, as well as hearing coverage. April 2022: Senators Wyden, Grassley, Cardin, Young, and Moran write to HHS in support of more transparency for OPOs. July 2021: Senators Wyden, Grassley, Cardin, and Young join a bicameral letter with bipartisan Members of the House Oversight Committee urging the Biden administration to accelerate the timeline for OPO accountability. February 2021: Senators Wyden and Grassley issue UNOS a subpoena, citing “serious concerns related to UNOS’ role in overseeing our nation’s OPOs, which have been severely underperforming for decades… [and] the improper use of Medicare funds, conflicts of interest and gaps in oversight.” October 2020: Senate Finance Committee investigation continues with a letter to the Secretary of the U.S. Department of Health and Human Services (HHS). February 2020: Senators Wyden, Grassley, Cardin, and Young launch a bipartisan investigation into UNOS. December 2019: Senators Grassley and Young ask the Office of the Inspector General to audit OPOs and UNOS for potential fraud. See Washington Post.

July 2024: Chair Comer writes to HHS and CMS about the urgent need for strict enforcement of the OPO rule. See Bloomberg November 2022: Reps Pressley, Porter, and Khanna join bicameral colleagues in letter to HHS calling for the breakup of the UNOS monopoly and release of “OPO process data for evidence of effective and equitable performance, and to hold failing OPOs accountable before 2026, given that any delay costs lives and constitutes an urgent health care equity issue.” November 2022: Reps Krishnamoorthi and Porter raise concerns about OPO data collection. See CBS Mornings with Gayle King. September 2022: Reps Krishnamoorthi and Porter write to the National Academies of Sciences, Engineering, and Medicine “Regarding Potential Conflicts of Interest in Organ Transplant Industry Study”. See Washington Post and Kaiser Health News. February 2022: Reps Krishnamoorthi, Pressley, Bush, Bass, Porter, and Maloney write to CMS urging OPO accountability and transparency. August 2021: Rep Krishnamoorthi writes op-ed about OPO “greed and self-dealing.” July 2021: Chair Maloney, Ranking Member Comer, and Reps Krishnamoorthi, Porter, and Cloud join bicameral, bipartisan letter urging the Biden administration to accelerate the timeline for OPO accountability as “an urgent health equity issue.” June 2021: House Oversight Committee “Expands Investigation into Fraud, Waste, and Abuse in Organ Transplant Industry” with a letter to the Nevada Donor Network May 2021: House Oversight holds a bipartisan hearing into OPO failures. See Washington Post. February 2021: Reps Porter, Krishnamoorthi, and Bass urge the Biden administration to finalize the OPO rule. August 2020: Bipartisan House Members including Rep Porter write to HHS urging finalization of the OPO rule. July 2020: Reps Porter and Bass urge HHS to finalize the OPO rule. December 2020: The House Oversight Committee launches an investigation into 16 OPOs for “shocking mismanagement” and conflicts of interest, and into the Association of OPOs (AOPO) for misinformation.

April 2025: “Ways & Means Seeks Public Input on Tax-Exempt Organ Procurement Organizations: Potential Violations of Medicare Reimbursement Rules, Misallocation of Resources, and Abuses of U.S. Tax Law”

May 2024: Office of the Inspector General (OIG) announces “Nationwide Audits of Organ Procurement Organizations and Certified Transplant Centers” February 2024: “U.S. to tighten rules governing use of donated transplant organs”, Washington Post September 2023: President Biden signs the bipartisan Securing the U.S. Organ Procurement and Transplantation Network Act into law. See CNN. March 2023: Biden administration announces OPTN Modernization Initiative, including plan to break up OPTN monopoly. See Washington Post. July 2023: United States Digital Service Report “Lives Are At Stake”— detailing failures of UNOS — becomes public. See Washington Post. April 2021: Biden administration re-finalizes OPO rule through midnight regulatory review. See Project on Government Oversight. November 2020: HHS publishes final rule for OPO accountability. See Washington Post. December 2019: HHS proposes new data-driven rule for OPO accountability. July 2019: President Trump signs Executive Order on Advancing American Kidney Health. See Washington Post. June 2016: White House hosts Organ Summit. See “FACT SHEET: Obama Administration Announces Key Actions to Reduce the Organ Waiting List”.

February 2025: “Organ Transplant System ‘in Chaos’ as Waiting Lists Are Ignored”, New York Times November 2024: “A man in Kentucky was wheeled into the operating room to have his organs harvested and yet ended up being discharged from the hospital alive”, Dr. Sanjay Gupta, CNN September 2024: “Medical Group Accused of Seeking to Collect Organs From Patient Who Was Still Alive”, Wall Street Journal April 2024: "Texas Surgeon Is Accused of Secretly Denying Liver Transplants", New York Times March 2024: "House committee launches investigation into organ transplant network", ABC News February 2024: “U.S. launches probe into possible fraud by organ collection groups”, Washington Post January 2024: “Organ transplant data breach grows to 1.5 million records", Richmond Times-Dispatch December 2023: “Data breach at UNOS exposes up to 1.2 million patient records”, Richmond Times-Dispatch August 2023: “The organ transplant system needs fixing”, Boston Globe editorial board July 2023: "Experts Demand Overhaul of Organ Transplant System During Senate Hearing", Medpage Today April 2023: “Black man awaiting kidney transplant alleges racial bias”, Washington Post March 2023: “Break up the human organ monopoly”, Washington Post editorial board March 2023: “U.S. Organ Transplant System, Troubled by Long Wait Times, Faces an Overhaul”, New York Times March 2023: “Dozens of Americans die daily waiting for an organ transplant. Why do we let this happen?”, USA Today January 2023: “Tonya Ingram Feared the Organ Donation System Would Kill Her. It Did.”, New York Times November 2022: “Investigation finds failures in organ transplant system: 17 to 20 people a day die on the waitlist", CBS News August 2022: “70 deaths, many wasted organs are blamed on transplant system errors”, Washington Post July 2022: “Thousands of lives depend on a transplant network in need of ‘vast restructuring’”, Washington Post April 2022: “The organ procurement system is failing people of color like me. It’s time for reform”, STAT December 2021: “Lawsuit alleges bullying tactics by transplant executives in bid to revamp system” November 2021: “Organ donation recovery rates worse for people of color, data show”, Axios November 2021: “Organ failure: The gatekeeper of Minnesota's organ transplant system is underperforming. It may be costing lives”, Rochester Post Bulletin April 2021: “America’s Transformative New Organ Donation Rule Goes into Effect Over Objections from Monopolistic Contractors” March 2021: “Trump’s Organ-Donation Policy Fix Would Save Lives”, Bloomberg editorial board October 2020: “Heartless: Organ Donation Contractors Lobby Against a Popular Health Care Initiative While Pocketing Pandemic Relief Loans”, Project on Government Oversight September 2020: “He died when he got the wrong lungs. It wasn’t the only organ error in SC that day.”, The Post and Courier August 2020, “Many die waiting for organs. The Trump administration could help.”, Washington Post editorial board February 2020: “How Lifesaving Organs For Transplant Go Missing In Transit”, Kaiser Health News October 2019: “Organ Failure: An American Horror Story”, Full Frontal with Samantha Bee October 2019: “Where you die can affect your chance of being an organ donor”, Associated Press October 2019: “How organ and tissue donation companies worked their way into the county morgue”, LA Times August 2019: “She Beat Cancer. Now She’s in Another Fight for Her Life”, New York Times editorial board June 2019: “11000 Americans Will Die Waiting for Transplants This Year”, New York Times June 2019: “Whistleblower threatened with being cremated alive after exposing mortuary kickback scheme”, CBS News February 2019: “Behind the failure of the first U.S. uterine transplant”, Washington Post February 2019: “Despite low performance, organ collection group gets new federal contract”, Washington Post December 2018: “Lives Lost, Organs Wasted”, Washington Post May 2017: “Last Week Tonight with John Oliver: Dialysis”