A car crash in May 2022 destroyed Katherine Screws’ small intestine, the organ that processes food and absorbs nutrients. For months, doctors at UCLA Health told her an intestine transplant might arrive in about six months. Instead, she waited three years.
Screws, an engineer and self-described food lover, spent months relying on IV nutrition, too ill to work or start a family with her husband. Her original transplant team had listed her for an intestine, but offers kept arriving—and being rejected. By late 2024, she had received nine rejection notices from OneLegacy, the local organ procurement organization, with no explanations provided.
Hospitals differ widely in which organs they accept. Some decline intestines due to technical difficulties, while others reject them based on surgeon preference. A 2023 study showed kidney transplant wait times can vary by 16 times between centers, depending on how aggressively they use organs from older or sicker donors. Intestines are particularly rare: only 88 were transplanted in the U.S. last year, compared to over 27,000 kidneys.
How a second hospital saved her life
Lisa Stocks, a nurse at OneLegacy, shared data with Screws showing how often intestine offers were declined—sometimes because of donor age or blood vessel complexity. Stocks also directed her to a patient-friendly database tracking transplant center performance. Within weeks of adding a second hospital to her list, Screws received a call: a donor in Chicago had an unusually long intestine, longer than most surgeons accept. Yet at MedStar Georgetown University Hospital, her new transplant team took it.
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Cal Matsumoto, the surgeon who performed the transplant, said the organ’s size was not a problem. “It fit fine,” he noted. The real challenge was coordinating retrieval, as intestines require careful handling of shared blood vessels with nearby organs, often demanding surgeons travel to recover them in person. “You can never predict these things.”
Why patients face opaque transplant waitlists
Screws’ experience reveals a larger issue: About one in five donated organs go unused, usually because a recipient wasn’t found in time. Patients often assume they’ll wait a set period, perhaps five years, and then receive an organ. But wait times vary by hospital, and few patients know how to ask why offers are declined or how to advocate for themselves.
Screws’ frustration stemmed from the lack of clear information. She had never heard of organ procurement organizations until her coordinator mentioned them. “She had never heard of OPOs until her transplant coordinator mentioned them or realized there had to be a bridge between donors and transplant surgeons. My main takeaway was that there is more subjecti”
By June 2025, Screws was eating solid food again. The transplant had succeeded, but the process had been a maze of unanswered questions, rejected offers, and a system focused more on efficiency than patient needs.
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Systemic failures leave organs unused
Screws’ case also exposed how the transplant system’s lack of transparency affects organ procurement organizations (OPOs). These nonprofits recover and distribute donated organs but operate with limited public oversight. A 2024 study found that OPOs vary in how aggressively they pursue rare organs like intestines, some prioritize them only when they meet strict anatomical criteria, while others accept them even with minor irregularities. Stocks noted that surgeons often cite concerns about long-term transplant success when rejecting organs, but these decisions are rarely explained to patients. “About one in five donated organs go unused, usually because a recipient wasn’t found in time.
For kidney transplants, the most common type, a large study found there’s about a 16-fold variation in how quickly a patient will get transplanted at one center versus another.” Stocks also added, “We offer them but they’re declined so often that it’s demoralizing.” The system’s reliance on surgeon discretion means patients like Screws may never learn why an organ was turned down, leaving them in the dark about how to improve their chances.
The push to use more donated organs has grown as the U.S. transplant system undergoes a major overhaul. Last year, over 49,000 transplants were performed, a record driven by increased donations from deceased donors. Yet about 100,000 people remain on waiting lists, most needing kidneys. The government is testing financial incentives to encourage hospitals to accept organs that might otherwise be discarded, such as those from older or sicker donors.
A Medicare pilot program is exploring whether penalties or rewards could reduce the number of unused organs, which currently stands at one in five. Meanwhile, some OPOs face threats of closure under a grading system that holds them accountable for the number of organs they procure, even though surgeons, not OPOs, decide whether an organ is suitable for a patient.