The U.S. organ donation system is undergoing a thorough overhaul. Many potential donor organs go unused, and thousands of patients die each year while waiting for transplants. 

Strategic placement of deceased organ donor care units and improved cooperation between organ procurement organizations could be part of the solution, according to LDI Senior Fellows Vishnu Potluri, Elizabeth Sonnenberg, Emily Vail, and colleagues. Donor care units specialize in clinical care and organ recovery from deceased donors and may provide more effective and efficient donor care than hospitals. But they are not available everywhere in the U.S. Donation service areas—discrete regions managed by organ procurement organizations— were established years ago and were never designed to optimize organ donation. The National Academies recommends that each organ procurement organization establish a donor care unit at the local level, but this recommendation ignores the wide variation in geographic size and number of organ donors across regions.

Using national data from organ donors and hospitals from 2018 through 2023, the investigators revealed that only 61.9% of organ donors were managed in acute care hospitals within a 180-minute drive of 34 operating donor care units.

Building on those findings, the researchers used mapping techniques to model changes. They found that adding 38 donor care units within existing service area boundaries would provide access for an estimated 92.7% of donors. Alternatively, if current service area boundaries were ignored, the number of donor care units would need to grow by only 22 to serve the vast majority (96.5%) of organ donors.

Potluri and Vail answered our questions about this novel approach to improving access to donor care units and its implications.

What is your most important finding about the current organ donation system and service area boundaries?

Potluri: Our study builds on past work suggesting that donation service area boundaries contribute to avoidable systemic inefficiency. Currently, a donor located closer to Philadelphia but in a neighboring service area cannot be transferred to Penn’s donor care unit, regardless of travel time or family preference. Allowing transfer to the nearest donor care unit would reduce the total number of units required nationally while significantly expanding their geographic reach—and potentially reduce inconvenience for the organ donor’s family.

How would you describe the problem of access to more donor care units?

Vail: The project demonstrates that donor care unit access is a system design problem. The potential benefits of donor care units will be realized only if donors in hospitals can practically be transferred there. Our study shows that geography and policy are intertwined: the location of facilities matters, but so do the rules that determine whether donors can be transferred to them.

What limitations of the study design should readers be aware of?

Potluri: We used location-allocation analysis to identify the best locations for donor care units across the U.S. This mapping technique is commonly used by city planners to decide where to place fire stations or ambulances, ensuring they can reach as many people as possible in the shortest time. We adapted it to find locations that would allow donor care units to serve the greatest number of organ donors while keeping transport distances short. One limitation is that we assumed all donors are transported by road, though some may travel by air ambulance.

How do you see the role of donor care units evolving?

Vail:  Donor care units have been in operation in the U.S. for more than 20 years, but their use is growing—in part because of enthusiasm for their efficiency and cost advantages over traditional deceased donor management in acute care hospitals.

In response to high-profile lapses in donor safety and allocation rule violations, there is growing scrutiny of the U.S. deceased organ donation system. In that environment, federal legislators and policymakers have expressed interest in systems-level solutions to reduce documented variation in donation processes and outcomes among hospitals and organ procurement organizations—the regional federal contractors responsible for donor identification and organ allocation in the U.S. Although best practices for donor care unit organization and operations have not been established, centralized donor management does offer a theoretical opportunity to standardize donor care delivery.

What are the policy implications of your study for the organ transplant and donation systems?

Vail: As the U.S. organ donation and transplant systems undergo restructuring and modernization efforts, donor care units offer a potential lever to improve donation outcomes by overcoming some system challenges (namely, hospital resource limitations and strain) and reducing practice variation. However, I’ve previously proposed regulatory and data collection infrastructure updates that are crucial to determining whether, and how, centralized donor care units may meet the diverse needs of system stakeholders.

Where are you going next with your research on the organ donation system?

Potluri: Organ donation can occur in two main ways: after brain death, which this study focuses on, or after circulatory death (when the heart stops before organ recovery begins). Donation after circulatory death is becoming increasingly common but involves tighter time constraints, different family considerations, and more complex logistics. We plan to examine whether centralizing these donors into dedicated care units is also feasible and beneficial, and what clinical and policy changes would be required.

Beyond modeling, real-world implementation depends on factors our analysis cannot capture: How families experience the transfer process, how hospitals and organ procurement organizations operate day to day, the resources available to each organ procurement organization for creating new donor care units, and whether financial structures incentivize or discourage donor transfers. Our model identifies where efficiency gains are theoretically possible; the harder question is whether the health care system can be reorganized in practice to achieve them.

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The study, “Geographic Accessibility of Deceased Organ Donor Care Units,” was published March 13, 2026 in JAMA Network Open. Authors include Vishnu S. Potluri, Vicky Tam, Elizabeth M. Sonnenberg, Richard D. Hasz, Joel T. Adler, Douglas J. Wiebe, Peter P. Reese, and Emily A. Vail.

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