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More than twenty thousand patients in the United States received organ transplants in 1997, yet over fifty thousand patients were still waiting for a transplant at the end of that year. Indeed, over four thousand patients died waiting for a transplant in 1997. The scarcity of organs highlights the need for a fair and efficient organ allocation system. Despite this need, not every patient in the United States has the same chance to receive a transplant. For example, in 1995, patients in Iowa had a median wait of twenty-eight days for a liver transplant. Patients in Pennsylvania, however, had to wait a median of 237 days for the same transplant. State-to-state disparity exists because of policies developed by the United Network of Organ Sharing (“UNOS”), the private organization in charge of the national organ transplantation effort. These policies generally mandate a preference for local transplant recipients in the allocation of human organs. For example, a liver procured in Iowa must first be offered to patients within the area of original procurement, then to patients in the surrounding region, and finally to patients in the rest of the country.

Organ Allocation and the States: Can the States Restrict Broader Organ Sharing?