United Network for Organ Sharing (UNOS)

The United Network for Organ Sharing (UNOS) is a private, non-profit organization based in Richmond, Virginia, that has served as the principal operator of the Organ Procurement and Transplantation Network (OPTN) under federal contract since the network's inception.[1][2] UNOS is not a government agency; it is a contractor to the Health Resources and Services Administration (HRSA).[1][3]

UNOS was awarded the first OPTN contract on September 30, 1986, not 1984, the year the underlying statute (NOTA) was enacted, and for most of the following four decades was the sole OPTN operator, running the national matching system (UNet), the around-the-clock Organ Center, and the policy-support apparatus of the network.[1][2] Under the OPTN modernization that began in 2023, UNOS's role narrowed, but it retained the core OPTN information-technology and matching contract.[4][5]

History

UNOS grew out of an earlier organ-sharing effort and was incorporated as an independent non-profit in 1984.[2] When HHS established the OPTN by competitive contract under the National Organ Transplant Act of 1984, UNOS received the initial OPTN contract on September 30, 1986, and began operating the national network.[1][2] In 1987, UNOS was separately awarded a contract by HHS to establish and operate the Scientific Registry of Transplant Recipients (SRTR), which it ran until the SRTR contract was competitively awarded to a different organization in 2000.[2][6]

UNOS launched its internet-based matching and data system, UNet, in 1999, replacing earlier systems for registering candidates and running donor matches.[2]

What UNOS does (as OPTN operator)

In its role as OPTN contractor, UNOS has historically:[1][2]

• Operated the UNet matching system that runs the "match run" pairing each deceased-donor organ with ranked candidates.
• Staffed the Organ Center, available 24 hours a day, to assist OPOs and transplant centers with placement and logistics.
• Maintained the national waiting list and the OPTN data systems.
• Provided staff support to the OPTN Board of Directors and committees in developing allocation policy (policy itself is adopted through the OPTN's public process and HHS Secretarial review, not unilaterally by UNOS).[1]

The matching logic and allocation rules UNOS executes are OPTN policy; UNOS implements rather than authors them. See How organs are matched and The donation pathway.

Role after OPTN modernization

The Securing the U.S. Organ Procurement and Transplantation Network Act (Pub. L. 118-14, 2023) authorized HRSA to award the OPTN's functions to multiple vendors rather than a single contractor, ending UNOS's exclusive operation of the network.[4][7] As part of modernization, the OPTN Board of Directors was separated from UNOS and independently incorporated, so UNOS's corporate board no longer doubles as the OPTN's governing board.[4][8]

As of late 2025, UNOS continued to perform a subset of the OPTN's work under an extension arrangement with HRSA, notably retaining the core OPTN IT/matching contract, while other functions moved to HRSA or other contractors.[5][4] HRSA structured the extension as short optional periods exercised at its discretion during the transition.[5]

Oversight and criticism

UNOS has been the subject of congressional and executive-branch scrutiny over technology reliability, organ-tracking failures, and the concentration of OPTN functions in a single contractor; this scrutiny was a principal driver of the 2023 modernization law.[7][9] Editors covering criticism of UNOS should rely on primary records, the text and findings supporting the Securing the OPTN Act, Senate Finance Committee materials, and CRS analysis, rather than advocacy sources, in keeping with a neutral point of view.[7][9][4]

See also

• Organ Procurement and Transplantation Network (OPTN)
• Scientific Registry of Transplant Recipients (SRTR)
• HRSA Division of Transplantation
• How organs are matched · The donation pathway
• Organ procurement organization (OPO)

References

• UNOS. UNOS and the Organ Procurement and Transplantation Network (OPTN). https://unos.org/about/who-we-serve/unos-and-the-organ-procurement-and-transplantation-network-optn/
• UNOS. The national organ donation and transplant system / About UNOS. https://unos.org/about/national-organ-transplant-system/
• HRSA. Modernizing the Nation's Organ Donation, Procurement, and Transplantation System. https://www.hrsa.gov/optn-modernization/learn-more-about-modernization
• Congressional Research Service. Organ Procurement and Transplantation: Administration, Oversight, and Policy Issues, R48426. https://www.congress.gov/crs-product/R48426
• UNOS. How UNOS' role in the OPTN has changed under the additional contract extension. https://unos.org/news/how-unos-role-in-the-optn-has-changed-under-the-additional-contract-extension/
• SRTR. The SRTR database / history. https://www.srtr.org/about-the-data/the-srtr-database/
• Securing the U.S. Organ Procurement and Transplantation Network Act, Pub. L. 118-14 (2023). https://www.congress.gov/bill/118th-congress/house-bill/2544
• PKD Foundation. Securing the U.S. OPTN Act Becomes Law. https://pkdcure.org/resources/securing-the-u-s-organ-procurement-and-transplantation-network-act-becomes-law/
• U.S. Senate Committee on Finance. Materials on the OPTN/UNOS oversight and reform. https://www.finance.senate.gov/