In 2018, a heart meant for transplant went missing on a commercial flight—and situations like that aren't as rare as you might think, according to a new Kaiser Health News (KHN) analysis.

2 ways health systems are making organ waitlists move faster

The US' donor organ shortage

The United States' organ shortage is well documented, particularly for kidneys. Research has shown that there are 93,000 people in the United States waiting for a kidney transplant, and kidney disease kills about 5,000 U.S. residents on the kidney waiting list annually.

The organ shortage has prompted doctors to try numerous tactics to expand the donor pool, including accepting organs from older donors and even re-transplanting previously donated organs.

That's in part why stories about donated organs getting lost or missing connections during transit garner so much attention. In the 2018 case, a human heart traveling on a Southwest Airlines plane from Sacramento to Seattle was not taken off the plane before the plane continued to its final destination, Dallas.

About an hour and a half into the flight to Dallas, Southwest learned the heart was still onboard. The pilot immediately made an announcement and turned the plane around to go back to Seattle.

Initial testing showed no damage to the valves, and Doug Wilson—EVP of LifeNet Health, a nonprofit organization that runs the tissue processing facility where the heart was destined—said the heart was able to reach the processing facility. "It got to us on time, so that was the most important thing," he said.

Is this common?

The case was originally dismissed as an "anomaly," but a KHN investigation into donor organs lost in transport paints a different picture.

In a partnership with Reveal, from the Center for Investigative Reporting, KHN analyzed data from more than 8,800 organ and tissue shipments from the United Network for Organ Sharing (UNOS), a nonprofit government contractor that oversees the transplant system.

Between 2014 and 2019, nearly 170 organs could not be transplanted and another 370 were flagged as "near misses," meaning the transplant was delayed by two hours or more due to transportation problems, according to the investigation. Twenty-two other organs that were originally unable to be transported were later transplanted at another location.

Of the transplants handled by UNOS, 7% had transportation problems, according to KHN.

Why are organs going missing?

So, what's the deal with organs disappearing on commercial flights?

According to KHN, "[o]ne contributing factor is the lack of a national system to transfer organs from one region to another." In an era in which consumers can track everything from Amazon purchases to online food orders, there is no system in place, or requirements, to track donor organ transit in real time, KHN reports.

Instead, the United States relies on 58 organ procurement organizations (OPOs) to collect, package, and label donor organs for shipping and delivery

Surgeons involved in the transplant often travel to hospitals to harvest and transport hearts because they are only viable for about four to six hours once they've been removed from the donor. But for organs that have a longer shelf life, such as kidneys and pancreases, OPOs often arrange transport via commercial airlines as cargo.

On these flights, the organs are given special cargo services, but they are largely treated like other baggage. And during the transit process, the organs often are tracked manually via phone calls and paper manifests.

As a result, in the same way luggage can miss a connected flight or get lost, the organs can be misplaced on or between flights.

But the commercial airlines are rarely held accountable for any delays or mishaps, according to KHN. All of the airlines declined to comment on the transplants.

Response

UNOS declined to release details on the transplants, and noted that transportation issues affect a small percentage of the 1,800 organ and tissue shipments that UNOS handles each year and an even smaller share of the nearly 40,000 organs transplanted in the United States last year.

Roger Brown, head of the Organ Center at UNOS, said an internal analysis of the transplanted organs revealed that more than 50% of the transportation issues were related to commercial airlines. Of those cases, two-thirds were caused by weather delays, mechanical delays, and flight cancellations, according to KHN. Another third were related to logistical issues, such as delayed package pickups.

However, a number of surgeons across the United States told KHN they've experienced organ travel problems first hand. 

David Axelrod, a transplant surgeon at the University of Iowa, said, "We've had organs that are left on airplanes, organs that arrive at an airport and then can't get taken off the aircraft in a timely fashion and spend an extra two or three or four hours waiting for somebody to get them."

But, while transportation problems account for a large number of "fail[ed]" transplants, Brown said there are other factors that can contribute to an organ being discarded. "The delay could be the primary reason an organ wasn't transplanted," he said. "It could be a contributing factor or it could have nothing to do with the reason that the organ is not transplanted."

Kevin O'Connor, CEO of LifeCenter Northwest, an OPO in Seattle, said overall, transportation problems are "minimal."

"For over 30 years and literally tens of thousands of organs being transported, I can count on the fingers of one hand the number of times that, because of a transportation glitch, an organ was ultimately not transplanted," he said.

But still, given there are 113,000 people on the transplant waiting list, O'Connor conceded that "even one kidney being thrown away because of transportation errors is unacceptable" (Aleccia, Kaiser Health News, 2/10).