Revamped organ transplant system faces funding questions

America's troubled organ transplant system is officially set for its first makeover in decades, but unresolved questions about funding could affect how swiftly reforms take hold, America's top health official said.

Why it matters: Reforms to the U.S. organ donation system — which for years has been plagued by problems like long wait times and wasted donations — will save lives, advocates say.

Driving the news: President Biden on Friday signed a bill into law that allows the administration to increase competition for contracts to run the Organ Procurement and Transplantation Network across the country.

• The new law also removes the cap on appropriated funding that can be awarded to contractors for the network.
• Biden's signing "opens a new chapter in our nation's organ donation system by addressing the many failures that have plagued the organ procurement network, with disastrous consequences," Sen. Chuck Grassley (R-Iowa) said in a statement.

Context: The United Network for Organ Sharing since the 1980s has been the sole organization contracted to handle distribution of donated organs, working with dozens of local procurement groups.

• A Senate investigation last year found 249 transplant recipients developed diseases from donated organs between 2008 and 2015. More than 25% of those patients later died.
• System failures also resulted in many organs getting lost or destroyed before they could be transplanted, the probe found.
• More than 100,000 people in the U.S. are on the transplant list, and over 6,000 die waiting for an organ each year.
• The Biden administration in March announced it would issue multiple awards to manage different parts of the transplant network, hoping to foster competition and increase transparency. The bipartisan legislation to support that overhaul quickly followed.

What we're watching: The Health Resources and Services Administration plans to solicit contract bids for the network later this fall. UNOS expressed support for a competitive bidding process and says it will seek to remain part of the system.

• Jennifer Erickson, a senior fellow at the Federation of American Scientists who worked on organ donation policy in the Obama White House, said she expects "a lot of innovators" to bid for the contracts, including organizations specializing in health IT.

• The Biden administration requested $67 million for the organ transplant program in fiscal year 2024, more than double the current funding level.

Between the lines: Congress still hasn't funded the government with just a week before the fiscal year ends, and conservative hardliners in the House are demanding major spending cuts.

• The government and contractors won't be able to fully modernize the system without more funding, HHS Secretary Xavier Becerra said.
• Becerra didn't specify which functions of the system require extra funding. But the Biden administration's funding request says the money is needed to make the system "more agile, user friendly, accountable, and equitable."
• "I hope everything starts to fall into place quickly," Becerra told Axios on Friday. "Some of [the policy changes] will take some money, too. Probably the best thing to say is: stay tuned."