What do kidney and pancreas transplants have to do with airplane regulations?
Tucked into the hundreds of pages of legislative language to reauthorize the Federal Aviation Administration is a provision to change the life-or-death process by which human organs are flown commercially from donor to recipient.
But where on the plane organs are stowed during flights has been a long-standing issue for organ procurement organizations.
The sweeping measure, which is pending in Congress and , aims to change regulations and move organs to the cabin from an aircraft鈥檚 cargo hold. Organizations managing organ transport consider it an opportunity to from a system they say adds more hurdles to the task of shipping organs.
It used to be that a member of a transplant team could take a packaged organ to a plane鈥檚 gate and hand it off to the aircraft鈥檚 crew, in the cockpit or on the flight deck. This access 鈥渁llowed us to really expedite the process,鈥 said , president and CEO of , a nonprofit organ procurement organization in the state. But the terrorist attacks of 9/11 led to tighter security protocols, including a rule that permitted only people with tickets to go through Transportation Security Administration checkpoints.
鈥淚n our case, we don鈥檛 have a ticket,鈥 said Casey Humphries, logistics service line leader of the , the nonprofit contracted by the federal government to manage the nation鈥檚 transplant system. 鈥淲e鈥檙e not booked as a passenger on a plane,鈥 she said. Instead, they鈥檙e part of the relay network bringing the organs to people in need. Airport employees who work behind security checkpoints have an airport badge and usually get in through a designated entrance.
Another consequence of the was that donor organs flown on commercial airplanes 鈥 which are mostly kidneys 鈥 were stashed in cargo spaces below the wing along with boxes and luggage, said Humphries.
But shipping organs as cargo requires they be at the airport for loading one to two hours before takeoff. 鈥淭hat鈥檚 a significant time before the wheels go up for the plane,鈥 said Orlowski. And that variable 鈥 the 鈥渉ours that the organ is going to just sit, going nowhere鈥 鈥 has to be factored into decisions about where it can be sent, he said. Donated organs can鈥檛 be treated like a golf bag or an Amazon box. They are delicate and have an imminent expiration date, which for kidneys is usually within 24 hours of surgical removal.
Since January 2022, around 80% of organs recovered in Oklahoma were sent to another state to be transplanted, Orlowski said. And of the organs LifeShare recovers, about 35% of them are flown commercially. Since kidneys can survive in a cooler longer than other organs, nearly all organs that travel on commercial flights are kidneys.
The first choice for transporting an organ, he said, is usually to drive it to its destination; it鈥檚 cheaper, and the transplant team can be more watchful.
But that鈥檚 not always an option, especially in rural areas. Orlowski said there are only two transplant centers within driving distance of LifeShare鈥檚 Oklahoma City base, in Dallas and Fort Worth, Texas. So his team relies on commercial airlines for transportation.
The current air travel security rules also cause geographic disparities, as fewer cargo-carrying planes fly in and out of smaller airports in rural areas, compared with airports in bigger cities.
鈥淲e need something that is available 24 hours a day because organs are available 24 hours a day,鈥 Humphries said.
Charter planes can be a backup option, but one flight can cost organ procurement organizations thousands of dollars, whereas cargo shipping costs usually come in at less than $500 per flight, Orlowski said.
Although the security protocol has been in place for more than two decades, transplant advocates say this is the first time they have sought a legislative reversal, and they are optimistic about the outcome.
The provision to allow organs back in cabins is included in both the Senate and House versions of the reauthorization bill. Some hot-button parts of the bill, though, such as an increase in the mandatory retirement age for pilots, could stall progress. The House Transportation and Infrastructure Committee on June 14, and at press time it was being debated on the House floor. The Senate Committee on Commerce, Science and Transportation is expected to consider this month, according to Senate staffers.
