United Network for Organ Sharing (UNOS)

UNOS' vision is a lifesaving transplant for everyone in need. UNOS is the private, non-profit organization that serves as the nation’s organ transplant system—the Organ Procurement and Transplantation Network (OPTN)—under contract with and oversight by the federal government. Stewardship of the gift of life entrusted to us and accountability for providing fair and equitable access to transplant for everyone in need are the values that drive our work every day.

To fulfill our mission, the UNOS Board of Directors adopts a three year strategic plan to identify and prioritize key initiatives that will help us achieve our vision of a lifesaving transplant for everyone in need. They, along with the UNOS executive team, continuously measure the effectiveness of every initiative and actively seek new projects that will meet strategic objectives.

UNOS strategic goals from 2021 to 2024 include:

• Increase the number of transplants
• Provide equity in access to transplants
• Improve waitlisted patient, living donor, and transplant recipient outcomes
• Promote living donor and transplant recipient safety
• Increase organizational capacity to serve the community

Increase the number of transplants
• Improve metrics and monitoring approaches for increased collaboration and performance improvement activities
• Pursue policies and system tools that promote system efficiency and increase organ utilization
• Increase the number of Donation after Circulatory Death (DCD) donor organs recovered and transplanted
• Review policies to determine whether future changes will be necessary to encourage or facilitate mechanical preservation during transportation of organs
• Increase living donation
• Conduct donor management research to improve practices

Provide equity in access to transplants
• Improve equity in transplant opportunities for multi-organ and single organ candidates
• Implement continuous distribution policy framework in all allocation policies to increase equity and provide more flexible, patient-focused allocation policies
• Increase the ability for allocation policies to be dynamic and incorporate changes in faster policy cycles
• Examine differences in access to transplant among different ethnic, economic and geographic groups and develop strategies as indicated to address any identified disparities
• Increase patient involvement throughout the policy development process
• Increase racial, ethnic and professional diversity on the Board and committees
• Continually increase the quality of OPTN data collected and explore the use of non-OPTN data to supplement policymaking and research

Improve waitlisted patient, living donor and transplant recipient outcomes
• Consider recipient longevity and quality of life in transplant center metrics
• Evaluate effective methods for assessing living donor outcomes
• Enhance transplant program tools and education in the selection and follow up of living donors
• Improve patient tools for understanding transplant center metrics and comparing programs, the allocation process and organ acceptance strategies, and living donation
• Improve the process/management of donor information that becomes available after transplantation

Promote living donor and transplant recipient safety
• Enhance sharing of knowledge about safety events, near misses, and effective practices across the transplant community
• Quickly share breaking information about COVID-19 and other emerging issues with professionals and patients

Increase organizational capacity to serve the community
• Communicate the story of the effective and continuously improving US donation and transplant system
• Communicate the needs of the donation and transplant community to government decision makers
• Engage the community and leaders in technology, science and research, to drive innovation and system improvement
• Engage patients in ways that improve their knowledge of the system and the organization that supports it
• Diversify revenue streams to be less dependent on OPTN revenues and restrictions
• Continue management and staff improvement and efficiency

Not only does UNOS have a eleven-year record of accomplishment of meeting or exceeding goals, but we also involve the transplant and organ donation community to do so. UNOS brings together hundreds of transplant and organ procurement professionals and thousands of volunteers through Board and Committee service. This unique collaboration in policymaking is truly democratic and the results help make lifesaving organ transplants possible every day.

UNOS is governed by leaders of the transplant community representing transplant centers and OPO's across the nation. Many of our Board members and staff either are transplant recipients or have a personal connection to transplantation and organ donation. The real world experience of transplant recipients, living organ donors, and family members of organ donors, brings the patient and organ donor perspective to the forefront of discussions around equity and safety. Additionally, medical and professional experts in organ donation and transplantation provide a breadth of knowledge and decades of experience to help shape goals, determine metrics, and make well-informed decisions supported by data. This is just one of the many strengths that enable UNOS to meet our goals.

UNOS thrives on a culture of continuous improvement. The organizational strategic goals, which are reviewed and updated by the Board and UNOS’ executive leadership every three years, permeate each level and every department. We track and link directly to the performance goals of all staff members, which culminate into the Chief Executive Officer’s dashboard. This dashboard updates in real time, and is just one of many ways UNOS is accountable to its goals. The Board has access to and reviews the organizational progress on a regular basis through each fiscal year.

Each strategic goal is tied to strategies that are tracked in an internal operational plan matrix. These strategies are assigned to departments whose leaders report out on progress towards the goal on a quarterly basis.

In addition to this meticulous tracking and commitment to accountability, UNOS recruits and maintains a highly skilled workforce in IT, research, data science, policy, behavioral science, philanthropy, business intelligence, communications, and finance – among other professional areas. Our mission-driven staff are the ones that keep us on track towards achieving our goals and maintain the complex, lifesaving system that matches the gift of life from generous organ donors to grateful transplant recipients.

In 2021, for the eleventh year in a row, organ donation from deceased donors in the United States set an all-time record. A total of 13,861 people provided one or more organs to save and enhance the lives of others, representing an increase of 10.1 percent over 2020. This resulted in 34,813 lifesaving transplants from deceased donors in 2021. Additionally, 45 OPOs set all-time organ donation records in 2021. A total of 6,541 living donor transplants were performed in 2021, bringing the total number of transplants in 2020 to more than 41,000 – the highest annual total.

As the highest-performing organ donation and transplant system in the world, UNOS is focused on equity in access to transplant. In late 2019, UNOS researchers began work on developing a dashboard that provides transparency about how the OPTN monitors equity in access to transplant. In March 2020, the first iteration of the dashboard went live for liver and kidneys. Through an Access to Transplant Score (ATS) and equity monitoring methodology, the Equity in Access to Transplant dashboard allows users to explore how different factors impact how long waitlist candidates have to wait to receive a deceased donor transplant. These data can alert UNOS to potential disparities in access to transplant and potential detrimental effects on equity, thus identifying when a policy refinement, communication to the community, or education and awareness are needed.

Another example of our progress towards our vision of a lifesaving transplant for everyone in need is UNOS Labs. UNOS Labs, an endeavor by UNOS to invest in innovative solutions for system-level issues in organ transplantation, began with a single project in 2017, and quickly expanded in mid-2018 to include an entire portfolio of projects. UNOS also invested in the addition of a Data Science team to the organization in 2018, supporting the data science pillar of UNOS Labs along with other corporate goals, and added dedicated staff resources to the UNOS Labs initiatives. Today, UNOS Labs is a robust experimental incubator that brings together data, technology, and industry expertise to test and develop new products and ideas for insights to improve the system.

The projects completed by UNOS Labs are a powerful example of UNOS’s commitment to innovating how we analyze, evaluate and continuously improve the national transplant system to save more lives. One example includes organ tracking.