KVIG Informative

Before asking what artificial intelligence is doing in organ donation, it helps to know how the system already works. The U.S. matches donated organs to patients with software and written rules, and that system is being rebuilt right now.

Who Runs It The Organ Procurement and Transplantation Network (OPTN) sets the rules for allocating donated organs. The Health Resources and Services Administration (HRSA) oversees it, and a contractor, the United Network for Organ Sharing (UNOS), long operated it as the sole administrator, according to the Government Accountability Office (GAO). Separate organ procurement organizations (OPOs) work with hospitals and families to recover organs. CMS certifies and grades those OPOs.

The Scale GAO reported in January 2026 that the U.S. performed 41,119 deceased-donor transplants in 2024 and that more than 100,000 people were on the waiting list as of May 2025. Each time an organ becomes available, the matching system ranks the candidates who could receive it, and transplant programs receive offers in that order. A program can accept or decline an offer for its patient, and a decline sends the offer down the list.

Scoring, Not Ranking by Category The OPTN is moving organ allocation toward what it calls continuous distribution. Instead of sorting patients into rigid groups by distance or blood type, the system scores each candidate using a weighted average of several subscores. A research group at MIT, working with a firm called Dynamic Ideas, describes how the weights shape who gets organs and has built a simulator to test different weights. Lung allocation has already moved to this framework, according to HRSA. Kidney and pancreas are still in development.

Is That Artificial Intelligence? A scoring formula that follows written policy is an algorithm, but it is not machine learning. In the HRSA, GAO and MIT material reviewed for this series, the national allocation system is described as policy-based ranking, and none of those documents calls it AI. Where AI and machine learning appear is around the edges: finding potential donors, judging organ quality, predicting which offers get accepted, and testing policy ideas. The next articles cover each.

The Technology Underneath GAO says the matching system has outdated technology and cybersecurity gaps. An HHS Office of Inspector General report dated Dec. 2, 2024 found the system’s cybersecurity controls only partially effective and identified 22 vulnerabilities. GAO says HRSA had implemented the report’s four recommendations as of December 2025. It also says a contract to identify improvements to the matching system was terminated for convenience in spring 2025 after a Department of Government Efficiency review.

The Rebuild HRSA is modernizing the OPTN by breaking up the single-contractor model. Its July 2026 update says it awarded a policy and committee support contract to CVP as a step toward a “multi-vendor OPTN,” and that it is pursuing rulemaking that would make certain OPTN policies directly enforceable by the HHS Secretary for the first time. The update does not mention the matching system, IT infrastructure or AI. GAO said HRSA had not yet developed detailed plans for the next phase of modernization, and HHS agreed with GAO’s recommendations.

The question for the coming year is who builds and audits the software that sits under the list, and whether any machine-learning tool gets added to it. Watch for HRSA’s next modernization update and the proposed rule on OPTN policy enforcement.