There had been growing criticism around the way the united National Organ Sharing Network allocated available organs. I have absolutely no idea if there was any basis to this. The one guy I know who underwent an organ transplant ended up getting assed out of one because VP Biden flew in and shut down medivac transport which meant the kidney and pancreas he was due ended up going to Portland instead. Then he eventually got a kidney and pancreas and proceeded to cook that one off in about eight years by failing to make the lifestyle changes necessary to maintain a donor kidney and pancreas. Mickey Mantle famously received a transplant one day after needing one only to die within months of cancer so there's going to be controversy around any attempts to distribute life-saving medical care in a truly egalitarian basis. That criticism came to a head about a year back and then we suddenly had to have an opinion about fucking RFK. I have no idea how this feeds into that but considering RFK's basic approach to healthcare is "toughen the fuck up" nothing would surprise me at this point. My father once observed that medical care in the United States is tilted heavily towards emergency medicine. There's nowhere in the world you'd rather be dealing with a gunshot wound... and you'd rather be almost anywhere else to be dealing with diabetes, for example. As there are far more people with diabetes than people getting shot (for now, at least), we end up allocating our spending rather poorly. Need surgery because your pancreas is kaput? We gotchoo fam. Need low-grade intervention to maintain your quality of life? bitch we have political fights about the constitutionality of capping insulin prices. The only country I know of that allows the sale of human organs is Iran, and Iran does not allow non-Iranian citizens to participate in the market as buyers or sellers. The prevalence of black-market organ transplants is pretty opaque; I can't find a study done more recently than 2008 and it was basically a web search.
Because of those exact concerns that you mentioned about the complaints and or critiques of UNOS a massive rule change that revised transplant criteria and donor criteria was passed around like 2022. All of the participating hospitals that I know of are still in the process of adapting to that rule change because it takes forever for these institutions to adapt their day-to-day protocols to be in compliance with the network rules. When I talk to patients and when I talk to providers they are still of the opinion that we are collecting data on what the overall change has been to the patient population as a result of the change in rules. Public health is not sexy and is always slow. It takes time to collect data it takes time to analyze results it takes time to change institutional paradigms. It's not good enough to simply change things just for sake of them being different. We have to make intentional choices about improving transplant care. And all of this is completely pointless to talk about because hospitals and research units are being gutted, left to die like their patients.