House Approves Costa Measure to Improve Transparency and Safety in Organ Transplant System

WASHINGTON - In a bipartisan vote this week, the House passed legislation containing Congressman Jim Costa’s (CA-21) Permanent OPTN Fee Authority Act, a key reform designed to improve safety, transparency, and reliability for patients waiting for organ transplants. The bill was included as Section 8 of the Mikaela Naylon Give Kids a Chance Act. 

The Permanent OPTN Fee Authority Act, led by Reps. Costa (D-CA) and Beth Van Duyne (R-TX) in the House and Senator Ron Wyden (D-OR) in the Senate, authorizes the Secretary of Health and Human Services to collect registration fees directly from Organ Procurement and Transplantation Network (OPTN) members for each patient listed for transplant. This change ensures stable, transparent funding for OPTN operations and completes Congress’s bipartisan effort to modernize the U.S. transplant system following the 2023 law that ended the decades-long UNOS monopoly. 

“As co-chair of the Organ and Tissue Transplantation Awareness Caucus, I know how critical it is that families waiting for a lifesaving organ can trust the system to be fair, transparent, and accountable. This bipartisan bill ensures that every dollar collected goes directly toward strengthening the network, improving outcomes, and giving patients the best possible chance at life,” said Congressman Costa. 

BACKGROUND
The Organ Procurement and Transplantation Network (OPTN)was established by Congress in 1984 under the Health Resources and Services Administration (HRSA) to coordinate organ donation and transplantation nationwide. For 40 years, the United Network for Organ Sharing (UNOS) operated the entire OPTN under a single contract. Congressional and independent investigations revealed significant failures in technology, equity, governance, and oversight. In 2023, Congress passed bipartisan legislation to break up the monopoly and enable competitive contracting. 

Why This Matters  

• More than 100,000 Americans are waiting for a lifesaving organ transplant, and system reliability is critical.
• The reform builds on the bipartisan 2023 Securing the U.S. OPTN Act by giving HRSA—not a private contractor—permanent authority to collect and manage OPTN registration fees.
• It will require the OPTN’s one-time registration fee that transplant hospitals pay when listing a patient on the national waitlist to be reviewed and approved each year through the OPTN’s budget process, as recommended by the OPTN Finance Committee, approval by the OPTN Board, and final sign-off by HRSA.
• It ensures sustainable funding contributed by transplant hospitals, Organ Procurement Organizations, and member institutions.
• It increases transparency by requiring quarterly reporting of fees collected, activities funded, and public dashboards with key performance data such as organ utilization and discards. 

The legislation is endorsed by UNOS, the AmericanKidneyFund, and the NationalKidneyFoundation, and now moves to the Senate for consideration.