Why this matters: LODRP provides eligible living organ donors with reimbursement for qualifying donation-related expenses, such as travel, lost wages, and dependent care. Under the HOLD Act, eligibility for reimbursement is no longer based on the organ recipient’s income. Instead, eligibility is based on the donor’s financial circumstances, helping ensure that a recipient’s income does not prevent an otherwise eligible donor from receiving assistance with qualifying donation-related expenses.
September 2026 update
OPTN Modernization is a coordinated effort to strengthen the nation’s organ donation, procurement, and transplantation system through safer care, stronger accountability, better data and technology, and more effective governance. Across these areas, HRSA and the OPTN are updating longstanding systems, policies, and oversight approaches to better reflect current clinical practice, public health and patient needs.
Three years of progress: from structural reform to results
September marks three years since the Securing the U.S. Organ Procurement and Transplantation Network Act was signed into law on September 22, 2023, giving HHS additional flexibility and tools to advance the OPTN Modernization Initiative. Over the past three years, modernization has reshaped how the OPTN is structured and overseen while strengthening patient safety, supporting families and health care professionals, and increasing transparency to the public.
HRSA has moved the OPTN from a longstanding single-contractor model toward a multi-vendor approach that brings specialized expertise to critical functions. It has also established a more independent governance structure, strengthened federal oversight, and advanced modernization of the technology and data infrastructure supporting the national transplant system.
These reforms are driving concrete improvements. HRSA and the OPTN have strengthened oversight of allocation out of OPTN sequence (AOOS) through standardized definitions and reporting, enhanced compliance monitoring, OPO Allocation Compliance Reports, and a public dashboard. Together, these tools provide greater visibility into allocation trends and strengthen accountability for compliance with OPTN policy.
Patient safety protections around organ donation and procurement have also advanced. HRSA has taken corrective action in response to identified unsafe procurement practices, directed the establishment of dedicated Patient Safety Officer roles within OPOs, and strengthened oversight of evolving donation and procurement practices. Work related to donation after circulatory death (DCD) and normothermic regional perfusion (NRP) is establishing clearer safeguards, strengthening processes for responding when safety concerns arise, improving information for potential donor families, and promoting greater consistency and accountability in donation and procurement.
Modernization is also improving transparency through better data. Public dashboards and reporting tools are providing greater visibility into system performance, while Transplant Data Services (TDS) and the Ventilated Patient Form (VPF) are creating a more consistent and reliable foundation for understanding organ donation, procurement, allocation, and transplantation. These improvements give patients and families better information, help health care professionals and researchers identify opportunities for improvement, and strengthen federal oversight of safety and performance.
Together, these changes demonstrate the broader purpose of OPTN Modernization: to make the national transplant system safer, more transparent, more accountable, and more responsive to the patients, donors, families, and health care professionals who depend on it.
The developments highlighted this month build on that progress, showing how structural and operational reforms are increasingly translating into practical improvements across the transplant system.
Key Developments This Month
- Support for living organ donors is expanding. HRSA finalized updated Living Organ Donation Reimbursement Program eligibility guidelines implementing the HOLD Act. The changes shift eligibility from the organ recipient’s income to the donor’s financial circumstances and strengthen support for donors facing donation-related expenses.
- Modernization of the nation’s transplant data infrastructure continues to advance. HRSA is transitioning procurement and transplant data to the secure, government-managed Transplant Data Services platform, which will serve as the authoritative source for national transplant data and support more consistent, efficient data collection and use.
- Patient safety protections are moving toward implementation. New OPTN requirements for donation after circulatory death take effect November 18, strengthening protections for potential donor patients, enhancing information sharing with potential donor families, and increasing transparency and accountability across organ donation cases.
- OPTN oversight, governance, and operational requirements continue to evolve. Changes to the oversight framework clarify how technology, network operations, and other critical functions are managed, while near-term milestones reflect the continued transition to a more accountable and modernized OPTN.
For patients, families, and the public
Updated living organ donation reimbursement program guidelines finalized
HRSA finalized updated eligibility guidelines for the Living Organ Donation Reimbursement Program (LODRP) to implement the Honor Our Living Donors (HOLD) Act.
On July 1, HRSA published a 30-day Federal Register notice outlining proposed updates to LODRP eligibility guidelines. HRSA received 43 comments from living organ donors, transplant professionals, and other stakeholders.
On September 29, 2026 HRSA is publishing responses to the comments received and finalizing the updated guidelines, which will be effective September 30, 2026. Living donor candidates can learn more about LODRP and apply for reimbursement through the National Living Donor Assistance Center (NLDAC).
Stronger oversight, transparency, and accountability
HRSA strengthens the nation’s transplant data infrastructure
HRSA is transitioning national procurement and transplant data to TDS, a secure, modernized, government-managed platform that will serve as the authoritative source for procurement and transplant data.
TDS will replace multiple legacy systems and support more consistent and efficient collection and use of data across the transplant community. The Scientific Registry of Transplant Recipients (SRTR) will continue its critical scientific and analytic role, using data from TDS to provide reports, analyses, research support, and other resources.
Why this matters: High-quality, accessible data are essential to a safe, transparent, and accountable transplant system. A modern, centralized data infrastructure will reduce duplication, improve data quality and consistency, and provide patients, researchers, health care professionals, and federal regulators with stronger information and analytic resources. Over time, these improvements will provide greater visibility into system performance and help identify opportunities to improve safety, effectiveness, and outcomes.
Update on the Network Operations Oversight Committee
As part of ongoing OPTN modernization and a broader review of OPTN governance, the OPTN Board of Directors has determined that the Network Operations Oversight Committee (NOOC) is no longer needed as a standing committee.
The environment in which NOOC was established has changed. HRSA now directly oversees multiple OPTN contractors, and changes to OPTN governance and operational responsibilities have changed how technology systems and network operations are overseen. Historical NOOC information and meeting materials will remain available online.
Why this matters: Technology and network operations remain critical components of OPTN modernization. As responsibilities and oversight structures evolve, the OPTN Board will continue to draw on relevant expertise through existing committees, workgroups, and other engagement opportunities, as appropriate.
Operational updates for OPTN members
Donation After Circulatory Death policy changes take effect November 18
New OPTN policy requirements for DCD will take effect November 18, 2026.
The changes strengthen protections for potential donor patients entering the DCD pathway, support informed decision-making by potential donor families through enhanced information sharing, and increase transparency, consistency, and accountability across organ donation cases.
What OPTN members need to know:
- The OPTN hosted an informational webinar on September 21. A recording of the webinar is available on the DCD policy webpage.
- Policy guidance and frequently asked questions will be available in the coming weeks.
- UNOS Connect training modules will be available in early October.
Important upcoming milestones
- October 1 — Fiscal Year 2027 patient registration fee: The OPTN Fiscal Year 2027 patient registration fee will take effect October 1. The fee will increase from $1,036 to $1,268.
- October 5 — Public comment deadline: HRSA is seeking public comment on a proposed information collection for applications and related forms for individuals serving on the OPTN Board of Directors and its committees. The comment period is open through October 5.
- October 1 — Ventilated Patient Form transition: The OPTN is transitioning to the VPF to support a more streamlined and standardized approach to collecting data from OPOs about patients referred for potential organ donation. Beginning October 1, all OPOs must use the VPF for patient referrals. Forms for patients referred during October are due November 30, 2026.
Engagement and collaboration
This month, HRSA participated in events focused on strengthening collaboration across the transplant community and preparing the system for continued advances in data, technology, and clinical innovation.
Collaborating across HHS to advance kidney innovation, data, and interoperability
On September 10, Dr. Raymond Lynch, HRSA’s Director of the Division of Transplantation, participated in the HHS KidneyX EMPOWER Prize Challenge Winners Showcase in Washington, D.C.
KidneyX, a public-private partnership between HHS and the American Society of Nephrology, recognized nine innovative approaches supporting living kidney donors and patients, including solutions using electronic health records, digital navigation, telehealth, and donor support.
Dr. Lynch also joined HHS representatives for a discussion on advancing innovation in kidney care. The showcase was followed by an Office of the National Coordinator for Health Information Technology Kidney Data Discovery Workshop focused on improving data standards and interoperability across nephrology, dialysis, kidney donation, and transplantation.
Why this matters: Collaboration across HHS and with the broader kidney community reinforces an important goal of OPTN Modernization: building a more connected data ecosystem across the continuum of kidney care. Better data standards and interoperability can reduce fragmentation, improve information exchange, and help ensure that critical information follows patients across care settings. These efforts complement HRSA’s Transplant Data Services work and the broader data and technology pillar of OPTN Modernization.
Engaging on the future of transplant innovation
On September 15, Dr. Lynch participated in the National Kidney Foundation’s Capitol Hill Roundtable on Kidney Xenotransplantation. The discussion brought together federal health officials, clinicians, bioethicists, a transplant recipient, and other stakeholders to examine the science, clinical and ethical considerations, policy questions, and patient needs surrounding kidney xenotransplantation.
Why this matters: Emerging approaches such as xenotransplantation highlight the need for a national transplant system that can adapt responsibly as science and clinical practice advance. OPTN Modernization is helping build that foundation through stronger data, technology, patient safety protections, and oversight, with continued focus on transparency, accountability, and the needs of patients and families.
OPTN board of directors to meet in September
The OPTN Board of Directors will meet in person September 28–29, 2026 to support public access and transparency. Open sessions of the meeting will be available via livestream for public viewing, and meeting agendas and livestream links are available on the OPTN Events webpage.
These engagements reflect a broader commitment to collaboration throughout OPTN Modernization. Input and partnership from patients and families, health care professionals, researchers, innovators, OPTN members, federal partners, and other stakeholders can help ensure that modernization addresses current needs while preparing the national transplant system for the future.
Moving forward together
Three years after enactment of the Securing the U.S. Organ Procurement and Transplantation Network Act, OPTN Modernization is delivering meaningful improvements across the national transplant system.
Stronger oversight, patient safety safeguards, better data and reporting, modernized technology, and expanded support for living donors are increasing transparency and accountability while strengthening care and decision-making. Continued collaboration with federal partners, patients, clinicians, researchers, and innovators is also helping the system adapt as transplantation evolves.
Modernization remains an ongoing effort. HRSA will continue building on this progress to advance a safer, more transparent, accountable, and responsive transplant system for patients, donors, families, and health care professionals.
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