Tackling the Organ Shortage

After Dan Dickinson was diagnosed with liver cancer and told he needed a transplant, he was called to the hospital four times for surgeries that didn’t happen. Each time, either he was a backup candidate or the donated liver turned out not to be a good match. During the 18 months he spent waiting for a transplant, he could not travel more than five hours from his home, since the call could come at any moment. Finally, on the fifth try, he received a healthy liver from a deceased donor in 2011.

“The emotional roller coaster of that was not fun,” says his daughter, Laurie Lee, who was so moved by the experience that she later donated one of her kidneys to a stranger and went on to cofound a company that supports both patients and living donors through the transplant journey. For his part, Dickinson became an angel investor in Pulse Charter Connect, an organ-transport logistics company founded by a Chicago Booth graduate. Both have become outspoken advocates for organ donation. “I felt an overwhelming sense that we won the lottery and we need to give back,” Lee says.

Dickinson was one of the lucky ones. Thousands of people die each year in the United States while waiting for an organ transplant, either because a donated organ does not become available in time or because they grow too sick to receive a transplant. In 2024, more than 100,000 people were on the national transplant waiting list. The overwhelming majority are waiting to receive kidneys, and while they generally can be kept alive by dialysis, their quality of life is often poor. People who need heart, lung, or liver transplants are at greater risk of dying before a donor organ becomes available.

The situation is similar in other countries. Nearly 180,000 organ transplants were performed globally in 2024, according to the Global Observatory on Donation and Transplantation, but only about 10 percent of the need is being met. As the world population ages, the corresponding rise in illnesses such as diabetes and cardiovascular disease increases the pressure on transplantation.

Even when donor organs are available, a fragmented and inefficient system for transporting them can leave them unusable. Communication problems, ground transportation challenges, and even bad weather can delay delivery of donated organs beyond their short period of viability, wasting their lifesaving potential.

But technological breakthroughs and changes to the process of distributing organs are raising the hopes of patients and physicians. Medical devices allow patients to live longer and more comfortably while waiting for a donor match, and new clinical trials focused on transplanting kidneys from animals to humans raise the possibility that shortages could eventually ease.

In addition, the US organ-allocation system is in the process of transforming. For 40 years, the public–private Organ Procurement & Transplantation Network was managed by the nonprofit United Network for Organ Sharing under an exclusive contract. The OPTN manages the national transplant waiting list, maintains the US organ transplant database, helps set US organ-donation and transplantation policy, and assists patients and their families, among other tasks. UNOS renewed its main contract at the end of 2025, but its scope is reduced, and the US Department of Health and Human Services is moving to a competitive, multivendor system. Goals for the new system include increasing innovation, updating technology, and more fairly determining transplant eligibility.

As the landscape changes, Chicago Booth faculty and alumni are among those proposing creative ways to adapt to the disruption. They are launching companies that aim to transport organs more efficiently and preserve their function while in transit, researching how to maximize transplants through better allocation, participating firsthand in the transplant process as physicians, and applying their Booth training to startups aimed at advancing the science.

Deciding Who Gets a Chance at Life

As soon as a donor organ becomes available, medical teams begin a race against the clock to match the organ with a recipient while the organ is still viable. A healthy donor heart, for example, survives outside a human body for only four to six hours using traditional storage methods.

In the US, a nationwide computerized network reviews the waiting list and first screens out patients who are incompatible with the donor organ because of blood type, height, weight, or other factors. Then the system determines the best match among the remaining candidates.

Each type of organ has its own allocation criteria, which may include medical urgency, the amount of time the patient has spent on the waiting list, immune-system compatibility, distance from the donor hospital, and likelihood of survival after the transplant. Patients who have previously donated a kidney or a portion of a liver to someone (“living donors”) are ranked higher on the waiting list to receive that organ. Body size is important, too, so children have priority for organs from other children.

Judging the quality of an organ and its associated risk factors adds complexity. Organs from older donors may lose function more rapidly, and organs from donors who have recently used intravenous drugs may be more likely to transmit diseases such as HIV or hepatitis C. In large part as a result of the opioid epidemic, one in four deceased organ donors may have engaged in behaviors that increase such risks.

Transplant surgeons can face difficult trade-offs on behalf of recipient patients. Should they accept an available organ with shortcomings or decline it and hope a better one comes along—soon?

The High-Stakes Hunt for an Organ

With thousands of lives on the line each year and the need for organs consistently outpacing supply, doctors, transplant centers, and policymakers navigate ethical quandaries as they determine how best to allocate the existing supply and increase the number of available organs while respecting the rights and autonomy of donors.

Reducing it to a simple supply-and-demand problem, economic theory would dictate creating a market for organs. A proponent of this approach was the late Gary S. Becker, AM ’53, PhD ’55 (Economics), University Professor of Economics and of Sociology at the University of Chicago and at Chicago Booth before his death, and a 1992 recipient of the Nobel Prize in Economic Sciences. Becker argued that transplant centers should increase supply by paying for organs from live donors or cadavers. (In 2007, he estimated a market value of $15,200 for a kidney and $37,600 for a liver.) Concerns about coercion and commodifying human bodies have held back this approach in most countries, but kidney donation from nonrelatives is legal in Iran, where donors receive compensation as well as health insurance. Within a year after the launch of this system in 1988, the number of kidney transplants nearly doubled—most of which involved unrelated donors. Sentiments about payments for organs in the US have warmed in the past decade, according to the National Survey of Organ Donation Attitudes and Practices.

At the same time, a worldwide black market for organs is thriving. In some cases, donors are tricked into participating or are forced to sell their organs. Illegal networks often take advantage of desperate people trying to find additional income to survive. Kenyan authorities, for instance, have been investigating an alleged organ-trafficking network connecting wealthy foreign patients with local brokers.

Transplant tourism—the practice of traveling abroad to find an organ when none is available at home, particularly under illegal or unethical circumstances—accounts for up to 10 percent of all organ transplants globally. Even when such transplants are performed legally, the risk for exploitation remains. In 2018, the Declaration of Istanbul on Organ Trafficking and Transplant Tourism affirmed that organ donation should be a financially neutral act and that countries should try to be self-sufficient in organ donation and transplantation.

A separate ethical dilemma, particularly as technology has advanced, involves changing definitions of what it means to die and when it’s appropriate to remove a patient’s organs for donation. Most organ donors are brain-dead, meaning they have experienced a complete and irreversible loss of all brain function. But in the case of “donation after circulatory death,” organs are removed from donors who have some brain function but are on life support and not expected to recover. In the US, more than 20,000 organs were removed from this type of donor in 2024, nearly double the total in 2021.

A recent federal investigation in Kentucky highlighted cases in which officials initially ignored signs of consciousness in potential organ donors. The donations in question were ultimately canceled, but the investigation found that the process should have potentially been halted sooner because the patient showed growing signs of consciousness. Most of those patients eventually died, but some recovered.