The feds want to overhaul how Americans get organ transplants. But in Philadelphia, the system gets high marks.

More than 6,000 people die in the United States each year while waiting for a kidney, liver, or heart transplant. Yet several thousand times a year, potentially viable organs go unused due to transportation delays, communication gaps, or outdated technology.

The longstanding problems have prompted a new Biden administration proposal to overhaul the system. Philadelphia kidney specialist Jerry McCauley is among many who welcome the plan — even though he is president of the organization that has drawn most of the criticism.

McCauley, the chief of nephrology at Thomas Jefferson University, heads the board of the United Network for Organ Sharing (UNOS), a nonprofit that manages the transplant system under contract from the federal government.

The Biden proposal calls for doubling the system’s budget, modernizing data collection, and improving oversight of 56 regional nonprofits that help to match organ donors with recipients.

Yet the contract would be split into five parts — meaning that UNOS might lose some of the work to another bidder.

McCauley agrees that there is room for improvement, but he says some of the criticism is misdirected.

“We are not disagreeing with or fighting any of these ideas that they have had. We applaud them,” he said. “But UNOS has been vilified for things that, frankly, we don’t control.”

Hundreds of articles have been written in medical journals about who is responsible for which shortcomings in the transplant system, and the issues also were the subject of a 2½-year, bipartisan investigation by the U.S. Senate Finance Committee.

Still, the number of organ transplants lately has soared in the U.S. — reaching 42,888 organs in 2022, more than double the number a quarter-century ago. And in recent years, UNOS and McCauley have been widely credited with improving one long-standing problem: lessening the disparity in kidney transplantation rates between Black and white patients.

» READ MORE: From 2017: New transplant rules help more African Americans get kidneys

But critics say problems persist at many of the 56 regional transplant nonprofits that UNOS oversees, called organ procurement organizations. More than half of these regional coordinators are failing or underperforming, according to the Centers for Medicare & Medicaid Services (CMS), using benchmarks established under the Trump administration.

In some cases, patients have died or become gravely ill after being transplanted with organs that were diseased or marked with the wrong blood type, according to the Senate investigation.

Yet 23 of the 56 nonprofits earned passing grades from CMS, including the one that coordinates transplants in the greater Philadelphia region. Called the Gift of Life Donor Program, it works with hospitals in eastern Pennsylvania, South Jersey, and Delaware.

CMS ranks Gift of Life in the nation’s top 10, as measured by a combination of its 15.6% donation rate (the percent of eligible donors who donate at least one organ for transplant) and its 42% transplant rate (the number of organs transplanted as a percentage of potential donors).

Philadelphia transplant surgeons agree with that assessment. Gift of Life is well known for its efficiency and empathy in helping area hospitals to match donors with recipients, said Antonio Di Carlo, surgical director of kidney, liver and pancreas transplantation at Temple University Hospital. Its officials have even advised organ transplant programs in other countries, he said.

“It is globally highly regarded,” he said.

Yet there is room for improvement, both in this region and nationwide. Di Carlo and McCauley agreed that no one should die while waiting for an organ transplant.

UNOS could always do a better job of overseeing the 56 nonprofits, McCauley said. But it has been hampered by outdated technology and a lack of resources, as evidenced by Biden’s proposal to increase the budget from $31 million to $67 million, the Jefferson kidney specialist said.

“Whenever anybody doubles the budget, that to me says you’re being underfunded,” he said.

Another problem UNOS cannot solve on its own is the prompt delivery of kidneys, McCauley said.

Unlike hearts and lungs, which deteriorate more rapidly and are typically rushed to hospitals on special organ-transport flights, kidneys travel in the cargo holds of commercial airplanes. As a result, sometimes kidneys are temporarily misplaced, and may fail to arrive at transplant centers within 30 hours, after which they start to deteriorate, McCauley said.

A better option might be to have couriers travel with kidneys inside the cabins of airplanes, but that would require approval from the Federal Aviation Administration, not UNOS, he said.

“The FAA does not allow a transplant worker to accompany the organ,” he said. “It’s picked up by a random worker and taken out to where it eventually gets to a transplant worker. The transplant worker can’t even come in and meet the organ at the plane.”