Rapid advances in organ preservation technologies mean that organs can travel further to reach the sickest patients in need of a transplant. However, our nation’s donation and transplantation system is increasingly reliant on commercial airline cargo processes that were not designed to handle this lifesaving gift.
Before the September 11 attacks, organs — primarily kidneys — were transported within a commercial flight’s main cabin under the supervision of the aircrew. The attacks prompted significant changes to airport protocols, including removing transplant professionals’ ability to accompany an organ through security without an airplane ticket. As a result, organs currently travel in the cargo hold and are subject to cargo business hours, which vary across the country and are impacted by staffing shortages. Organs arriving when a cargo office is closed sit on ice for prolonged periods, increasing the potential for an organ not to be used.
Though year-over-year records in organ transplants demonstrate that the vast majority of organs arrive safely at the transplant center, still some experience cargo handling-related issues. Even in a perfect world, delays due to weather are uncontrollable, but delays due to cargo processes, failures to load on initial or connecting flights, and misdirected shipments are avoidable.
Pushing for change
United Network for Organ Sharing (UNOS), the nonprofit organization that has managed the nation’s transplant system for 40 years through a federal contract, sought Congressional support to enable couriers and organ procurement agencies to deliver donor organs directly to an aircraft, returning to in-cabin transport.
As a result of UNOS-led advocacy and with the support of the organ donation and transplant community, on May 16, 2024, Congress passed a bipartisan bill requiring the U.S. Department of Transportation (DOT) and Federal Aviation Administration (FAA) to convene a working group to identify best practices and hindrances to make recommendations for the transportation of donated organs in the passenger cabin.
The bill’s passage highlights the bipartisan consensus and understanding of the lifesaving importance of this issue. It shows a commitment to honor the gift of life and do right by patients, generous donors, and their families, and to bring organs back into the aircraft cabin.
The FAA is dedicated to improving flight options to honor the gift of life and patients on the waitlist, and they have already launched the working group. The working group includes organ procurement organizations, transplant hospitals, commercial airlines, flight attendants, and other federal agencies. Recommendations from the working group will be included in a report that is expected to be released next year to support organs flying in aircraft cabins.
By working together, the organ donation and transplant community, Congress, government agencies, and the commercial airline industry can ensure that donated organs are again handled with the care they deserve, leading to more patients receiving a lifesaving transplant.
