Totally Transplant
A podcast addressing all things Solid organ transplant. Dr. Samra, a transplant nephrologist, discusses all things and answers questions sent in by listeners.
Totally Transplant
UNOS and understanding the modernization of the OPTN with Devin Holland
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Dr. Samra sits down with Devin Holland, the Business Development Lead at UNOS, the United Network of Organ Sharing.
In their conversation they highlight the modernization of the OPTN(Organ Procurement and Transpantation Network and the future of UNOS.
They also discuss the upcoming Transplant Management forum happenign in Atlanta, GA April 29 to May 1, 2026.
https://unos.org/about/tmf/
Please note this is not medical advice. It is meant for entertainment purposes only.
Hello, everyone, and welcome back to another episode of Totally Transplant. This is your host, Dr. Manfreet Samra. We have a very special guest with us today, Mr. Devin Holland. He is the business development lead at UNOS. And before you ask, what is UNOS? We're going to ask Devin to introduce himself and we'll get right into it.
SPEAKER_00Yeah. Hey, everyone. Nice to be on here. Happy that you uh had me, Monfreet. Appreciate it.
SPEAKER_01Yes. And um, so tell us about your role within the transplant world and how you entered UNOS.
SPEAKER_00Sure. So I'm actually relatively new to the transplant space. I joined UNOS about two years ago at this point, but I've been in the life sciences healthcare space for almost a decade at this point. Um so I kind of got my career started off in this space, in the consumer research space, consumer healthcare, laboratory instruments, diagnostics, and then moved over really into working closely with pharmaceutical companies, whether that was like early discovery research, clinical trials, regulatory intelligence. So I come from more like the commercial side of things. And prior to UNOS, I was at a smaller startup company, you know, working with closely with pharma companies in different therapeutic areas. And that company was going through some changes prior to an acquisition. So I was actually looking for another role. And how I wound up at UNOS is, you know, after working in the life sciences for a long time and being kind of indirectly involved with improving patients' lives, I really wanted to do something that was more directly mission-driven, you know, that had a more direct impact on people. So when UNOS reached out to me looking for someone with more commercial expertise to help with their, you know, non-OPTN, you know, money generating efforts, just so the business could be more sustainable, so we could invest in more things for the community. It seemed like a great fit because here I was, you know, being able to apply my commercial expertise with something that, you know, with every transplant, you're literally saving that person's life. So it really felt like this more direct connection to the patients that we serve. And I still get to work with, you know, a lot of people on the farm and med device space that kind of play in this area. So it's really combining what I was looking for with what I was doing previously. And I really enjoyed it so far. Like this space is so fascinating and so complex. I feel like every time I peel a layer of the onion back, there's like a whole nother onion underneath. And I feel like that every single day. You know, if I'm here for 10, 20, 30 more years, I feel like I'll still be learning things about organ donation and transplantation. It's incredible.
SPEAKER_01I'm so glad that's a great fit. And thank you for the work that you're doing. For patients that are listening, we've mentioned UNOS many times. You know, patients are familiar with their disease, their kidney disease. They may be familiar with dialysis and they get to be familiar with transplant through the different phases, the pre-transplant wait list, and the post-transplant phase. Could you share with the audience what UNOS is and what it stands for?
SPEAKER_00Yeah. So UNOS stands for the United Network for organ sharing. I feel like patients know who we are to various degrees, because for a lot of things, we sort of live in the background. So UNOS really manages a lot of the technology infrastructure that lives behind the scenes. You know, we're capturing the people who enter the national organ wait list. You know, they go into basically our database. And then for potential donors that are out there, whether, you know, they're go through some traumatic brain injury or cardiac death or something, whatever results in them, you know, being able to contribute the gift of life to another person, they enter our database as well. And then our database kind of looks at these different people that are on both sides of the equation and takes into account all the policies that are out there to try to like make this whole matching process very equitable and accessible to everyone. And then our system actually runs the match and connects that organ that's being donated to someone on the wait list who we believe is the best fit based on all the research and policy that the community has enacted over the past 30 to 40 years. So we've done a lot of work on the technology side of things, managing all that data collection and intake and the actual matching process. But we've also kind of stewarded this whole system over the last few decades, kind of managing all the other pieces as well. So patient safety, you know, managing uh committees that are created to enact new policies, you know, talk about different organ allocations, things like that. So we touch a lot of pieces of things, even though our team might not be the most visible to the patient per se. You know, we're not there at the hospital. We don't actually physically handle any organs, right? It's a lot of the behind-the-scenes stuff that just makes sure the system operates smoothly.
SPEAKER_01Exactly. And for patients, I feel like their first indirect introduction to UNOS may be hello, Mr. Smith, you have an organ available. And these are the details. And all of that has come from this clear description you've given of what UNOS is, the technology that you use, the management that's done of the incoming data, and then the managing and the equitable allocation of organs that happens thereafter. Thank you. So there is UNOS, the umbrella. And then underneath UNOS, there are two separate entities. Could you go over with us what those are and what the different functions are?
SPEAKER_00Yeah. So for a long time, I think people sort of saw UNOS as being equivalent to the OPTN. And for those of you listening who might not be familiar with that acronym, it's the organ procurement and transplantation network. So it's really like the name for this whole system and all the pieces that are involved underneath it, right? UNOS, the OPTN is really kind of this government framework, this contract basically that manages how the system operates and the different kinds of rules, laws, and regulations that apply to it. UNOS for 30 to 40 years, I think over 40 years at this point, has kind of managed the OPTN as the government contractor. So we've been like the steward of that whole system. But UNOS exists as a private nonprofit entity. So, you know, think of this as being a government program that us as the nonprofit have managed for 40 years. But UNOS has also historically done a lot of things outside of that government contract as well. We've done research work, you know, working with pharma and med device companies, you know, to create some innovative solutions for this market. We've worked with surgeons and academic researchers to investigate, you know, different things as it relates to policy and organ access and equity and things like that. But we've also kind of produced some solutions of our own to help the community. Those of you might not be familiar, but we actually have kind of an organ tracking solution. And this was the first kind of organ tracking solution used in this space that a colleague of mine, Casey Humphreys, started up here about five years ago. I think organ tracking now is a bit more ubiquitous, but at the time it was seen as this innovative thing of like, you know, we can track our packages, but why can't we track where our organs are at any given time? So we've done, you know, dabbled in those sort of things as well. That's kind of the stuff I oversee. I don't really touch too much of the OPTN contract side of things, but I think that's what UNOS is more well known for, if that makes sense. Just because most of the people we interact with on a day-to-day basis, the donor hospitals, the organ procurement organizations, the transplant centers are all members of that OPTN system. So they're kind of interacting with the OPTN side of UNOS on a day-to-day basis and not necessarily with the piece that I represent. We've always lived on the background, you know, my side of UNOS, but I think, you know, we're we're coming to the forefront more and more nowadays.
SPEAKER_01And where you said UNOS has been around for over 40 years. Can you share with us how UNOS was started, sort of the history of UNOS, if you will?
SPEAKER_00Yeah. So to take you in a time, transport you back in time a little bit, back in the 1970s when organ transplantation was really becoming medically viable, you know, that organs could be put into another person to save their lives from different chronic diseases. There wasn't a matching system to figure out who is the best fit for this organ. So it was really, you know, and I'm not a clinician, but it was really kind of like experimental in a way, but with like all types of medicine, you know, it starts out there and then we try to figure out how to regulate it afterwards. So in the 80s, Congress passed what's called the National Organ Transplant Act. So this is what basically created the OPTN framework that we're all familiar with today. But as part of that, they need to figure out okay, who's gonna manage this whole system? Uh UNOS was actually incorporated around the same time for the express purpose to help manage the system. And again, I don't know like my history exactly, but I believe VCU in Virginia was one of the first like major transplant institutions back then, which is why UNOS is also based in Richmond, Virginia. We're like physically very close to VCU and have a really good relationship with them. So that's kind of like the history behind that a little bit. So for the next 40 years, UNOS helped build and operate this whole new national transplant system. And this is something that to this day remains pretty unique, you know, in the world. Um, there's other countries out there like Spain and Australia that have kind of their own programs, but the US system operates, you know, kind of in its own way compared to those. So this is really you know, running that national organ wait list, running an organ placement call center, developing the allocation policy with the community, managing the data, um, all those kind of things incorporate what we've done over the course of that contract lifetime, which obviously is changing in many ways today, but historically that's kind of has been UNOS's role in the system, helping it grow and kind of just like moving it from its infancy to where it is today.
SPEAKER_01That is an excellent overview of UNOS, where it was, and that segues perfectly into where UNOS is now. And with the introduction of the OPTN Modernization Act, there are changes occurring literally as we speak. Can you share with us um the what the OPTN Modernization Act is, some changes that have occurred and what we can look forward to?
SPEAKER_00Yeah, so the Modernization Act occurred or was passed a little bit before I joined UNOS, I believe back in 2023. And the whole goal of the Modernization Act was really to improve the OPTN technology, increase data transparency, analytics, governance, operations, quality improvement, basically turn the system that has existed for 40 years and modernize it, hence the name. This has been kind of a slow process to get to where we've been since 2023. I don't think like the changes basically kicked off with the signing of that. I think we've really felt impacts probably in the last six to 12 months as a community. UNOS is very aligned with the modernization initiative. We agree there's like a lot of opportunity here to improve the system, make it more streamlined. But there's a lot of changes that still need to happen. You know, UNOS, as I mentioned, used to have stewardship of basically this entire contract. And now, you know, different pieces live with different people. So there's other contractors in the mix now, they have their own special expertise, and the pieces of the system that have been given to them are based on that specific expertise. So all of us have our own little domains that we kind of operate in and that we're overseeing that we've kind of been tasked with modernizing. So, as mentioned, you know, UNIS operates a lot of the behind-the-scenes tech infrastructure of this whole system. So one of the things that we've recently been tasked with is moving the OPTN tech infrastructure to the cloud. So rather than it living like in a server room somewhere in Richmond, you know, this is now on modern cloud tech infrastructure, which makes it so that we can make changes a lot faster. It's not as vulnerable to different risks, things like that. So we're kind of managing our piece, the other contractors are now managing their pieces, and we're kind of all working together to try to make a better system.
SPEAKER_01So does UNOS then still preside over or manage the different contractors now that have taken over their specific expertise roles?
SPEAKER_00We don't manage those. Um, some of them, you know, we're going to be working with now and in the future, because you know, if you think of this as sort of like an end-to-end process, you know, we have this piece that process, but we need to interact with the people on both sides of us, right? It's really HERSA and the government that's managing all the different contractors and and in what domains they kind of have control over. So we're obviously talking actively with our counterparts in the federal government for the pieces that we're responsible for. But you know, we've we don't have great visibility on what's happening in those other domains just because you know UNOS isn't the one operating those different pieces of the system anymore.
SPEAKER_01Understood. So it's the contractors.
SPEAKER_00Exactly. Yeah, like the single UNOS is now like the many UNOS, is if that makes sense. It's probably a terrible way to explain it, but you know, the one is now the many.
SPEAKER_01Yeah, the one has now been almost compartmentalized into many um with their specific domain expertise.
SPEAKER_00Exactly. Yeah.
SPEAKER_01And a large part of this, to my understanding, is to improve transparency, improve equitable distribution and allocation. And then a question I had is from a financial standpoint, does this eventually become more efficient as well? I imagine there's a lot of upfront investment costs.
SPEAKER_00I think that's the question on everyone's mind right now is like, is this new system and this new structure going to be more efficient and more cost effective? I think it's a little too early to tell at this point, because you're right, you know, there's a lot of upfront investment and development costs that go into turning the one into the many, right? I do know, you know, for the pieces that UNOS no longer has, you know, direct control over. Now, some members of our organization are now at some of those other organizations. So some of the same people are still working in different pieces of the system, which are fantastic because everyone I work with, Unos is like 100% dedicated to the mission. So it's very nice to know that these people are still kind of working on different pieces of things, even if they're not necessarily at UNOS. But we're only really six to 12 months into the actual modernization changes, at least as far as I can tell. So I think it's a little too early to tell like how we made things better. You know, I think we're all striving towards that, we're all working towards that, but it's just we don't have enough data to know for sure.
SPEAKER_01Yeah. And and what I hear you saying also is because the folks that were dedicated to units earlier are now dedicated to these contractors. And I'm hearing that there's continuity, which I think is very important because, you know, as we talked about early on, transplant is very complex. And to have that foundational knowledge allows you to do your job better.
SPEAKER_00100%.
SPEAKER_01And even possibly as le maybe they serve as liaisons to the different, you know, committees that will be formed.
SPEAKER_00Yeah, I'm really curious how all that will pan out. But yeah, I do agree. Like transplant is such a I hate to word use the word niche because it does affect so many people's lives, but it's so different compared to like oncology or other broader areas that if a company that is more involved in like the healthcare space tries to get involved into transplant without fully understanding really what they're getting into, I think it's gonna be a wake-up call. Like there's so much different data that lives in different places, it's hard to wrap your arms around it. So I sleep a bit better at night, knowing that people that have kind of been intimately familiar with different pieces of this whole system still kind of exist in here, even if they're not necessarily wearing the UNOS hat.
SPEAKER_01Yeah, no, I I think that makes a lot of sense. And with the UNOS, the private nonprofit entity, can you share a bit more about what the goals of this part of the organization are?
SPEAKER_00I think that's the magic question, right? Everyone asks, you know, like what's what's happening at UNOS now? And I I really think we're still trying to figure out what we want to do when we grow up. Like I said, for 40 years, like UNOS has all been about supporting the OPTN and making sure it's running smoothly, improving pieces of that system as part of the government contract. I think now we're really trying to figure out like how do we want to support and show up for the community outside of that government contract. There's always been things that we've done in the past, like I think I mentioned, you know, we've done various research projects for commercial companies, for academic folks, for surgeons, but all that has really been sort of side of desk work. Like, you know, someone in a research team or a biostatician on our team would put on their UNOS private hat for a few hours a day and work on this project and then afterwards go back to their OPTN work. But now I think we're starting to shift our focus as this contract landscape shifts a little bit to doing more of this UNOS private work, as we sometimes refer to it as, as UNOS, the private nonprofit. And we're still kind of figuring out exactly what we're doing. You know, we've played in a bunch of different areas just because of our nature of involvement with the community. We've had our hands and in so many different places and have built relationships with so many different people that we could go in so many different directions, right? But we're a nonprofit, we're a company of 200, 300 people, so we can't go in every direction at the same time. We kind of have to pick what we're going to be prioritizing, which will be the best fit for us as an organization, but will also deliver the most value to the people involved in this space, whether that's the transplant hospitals, the OPOs, the companies making new products for patients. I think we have a lot of options, and that's something that I'm working closely with the leadership team here to figure out like what is the best fit for us at this time that we're going to kind of really commit to in the next few years.
SPEAKER_01When do you think we'll know what those priorities are?
SPEAKER_00Soonish.
SPEAKER_01Okay. So we'll have to have a follow-up to go over that.
SPEAKER_00Yeah, I think so. I think if we had this conversation six months from now, you know, we would have a lot more to talk about on my side of the house. A lot of it obviously is internal conversations that we're having right now, but we are talking very closely with many different members of the community just to figure out what challenges are they experiencing that the government system can't solve for them? Or what things can we do as a private organization that can be done very fast and nimbly. We might not have the time to go through the standard regulatory process that takes a few years. And I'll use the example of adding data into the OPTN data collection system. Now, there's technologies that have been on the market for years now, like different perfusion devices, NRP, where the data collection of the system has just started collecting data on that in the past year or two. But those technologies have been used for four or five plus or more years in some cases. So, what can we do as like a private company working directly with the players in the space outside of the framework of that contract where we can really add value and solve problems for them?
SPEAKER_01Well, we will all be very interested in knowing, but there is something that you are working on right now that we can talk about, and that is the Transplant Management Forum.
SPEAKER_00Yes. So, you know, this is like an event that UNOS has run for 34 years now. I think this is our 34th year. This is something that we've always done outside of that government contract. So UNOS nonprofit runs this event. Historically, it has been for transplant program administrators, so at the transplant hospitals, and it basically serves as a forum where people can come together, discuss the different challenges they have, best practices, solutions to those challenges, and foster some of those critical conversations in the community. I mean, there's what 250 plus transplant centers, so that's a lot of different programs, and each of them do things a little bit differently.
SPEAKER_01Oh, yes. If you've been to one transplant center, they say you've been to one transplant center.
SPEAKER_00Exactly. They say the same thing about OPOs, right? You know, that's kind of been the historical reason for this event. And it has been, you know, very successful. We have great engagement for the community. I think it's one of the largest transplant events outside of the American Transplant Congress, you know, ATC, which is has been the big annual conference for transplant and WTC, like the international counterpart to that. This year, you know, I think with all these modernization things happening and all these changes happening at UNOS, we're also evolving TMF in a similar way to be more modern, to fit the landscape that we're all trying to operate in right now. So we're starting to work in more of like the innovation side of things, the technology side of things into the event. And we're bringing some of our partners in those different spaces to sit at the same table as these people from transplant centers so they can really talk together. Because I don't think for a lot of these challenges, they can be solved. In a vacuum anymore. Yes. So the content is kind of a mixed mash of those two worlds. Like some of it is very that historical. Like, hey, what is your program doing? Like, what how can it help my program? A lot of it is fostering conversations between like what else exists out there? What other kind of external perspectives can we bring into this mix to solve some of these challenges? Because I think more so than any other point in time, like this organ donation and transplantation landscape is changing faster and faster and faster. And I don't see it slowing down anytime soon. So new technologies like you know, organ profusion, artificial intelligence, new innovative ways to do patient communication, xenotransplantation, you know, might finally happen.
unknownYes.
SPEAKER_00I know it's it's that goalpost that keeps moving, but you know, clinical trials are happening in the space now, and it seems pretty promising. I think that's why this year's TMF tagline is transplantation for tomorrow, where innovation meets action, because it's great to sit down and talk about these things, but it's better to actually do something about them. So I know we have an event towards the end of the conference, which we refer to as kind of the regional roundtables. UNOS used to operate these different regional meetings to kind of get people together and just talk about their local issues, right? And to have a concrete plan of action for how we're going to solve those. And I think this is kind of a reenvisioning of that a little bit. I think the regional meetings kind of died off around COVID because a lot of events, you know, COVID was the death of those events, unfortunately. So we're reviving it and reenvisioning this. And we want to kickstart some of those conversations so that we can work them into our efforts as the private nonprofit organization and actually create some solutions to address them so that when we meet up at the next TMF in 2027, we're going to be able to show people like, hey, here's the challenge you talked about. Here's how we showed up and took a stab at solving it. Like, let's keep working on this together. We want to make this event very actionable for the community.
SPEAKER_01Wonderful.
SPEAKER_00Yeah, I'm really excited. It's going to feel a little bit different than TMFs, but I think that's a great thing. And you know, the event's going to keep evolving. And so yeah, we'll we'll kind of see how it goes. This is also the first time I've been involved at this level of planning for the scale of event. So it's been a learning experience personally as well, but we won't get into that on this.
SPEAKER_01Can you share with us where and when the TMF forum is happening?
SPEAKER_00Yeah. So TMF is happening in Atlanta, Georgia from April 30th to May 1st. So coming up in a few weeks once this goes live. So looking forward to seeing everyone in the community there and having you be part of these conversations about what the future of transplantation should look like.
SPEAKER_01You've outlined um really well what the focus of TMF is going to be. Who is the ideal attendee? Who can attend the TMF?
SPEAKER_00Yeah, so I think the best fit for TMF are the people involved at like the program operational level. So program administrators, nursing coordinators, managers of staff, technology involved folks, like whatever kind of that executive suite equivalent is for a transplant program, like I think a lot of the content in the program is shaped for you. I think with the you know slightly shifted focus of TMF this year around, I would actually broaden that lens to other people in the community as well, but have been more involved on the product innovation and technology side of things. You know, even if you don't work at a transplant center, if your organization is doing something really innovative, we want you there being part of the conversations with us. We want you showcasing your solutions so people can react to them and tell you how to shape them for the future. Um, so it's really the combination of those two audiences that I think is really going to make this work. We really have to come together as a community because if we're not going to make change together, who is?
SPEAKER_01I agree. I mean, you are so right that otherwise we can be so siloed, whether that's in transplant programs or whether that's specifically even within the transplant program. But my goodness, to have this forum to share these ideas and to help implement these ideas and to take action, that's exactly what our transplant community needs. So thank you.
SPEAKER_00Of course. Thank you.
SPEAKER_01When I wrap up the podcast episode, I like to ask where you think the future of transplant is going. Um, and I feel like you've already outlined that. But if there's anything else you'd like to add, please do.
SPEAKER_00That's a really tough question. I'll just pick one piece of the pie, I guess. I work really closely with our data science team. So you know it's just heavily involved trying to figure out, you know, what's the role of artificial intelligence in all of this, right? And I think there's been some great conversations at other annual meetings about, you know, the role of AI versus the role of the human in decision making. One thing that I think we're all very aware of is data in transplantation is very siloed. I think that can be said similarly for a lot of areas of healthcare. And it's something that I think collectively, like the healthcare community is working on. But I think it's especially relevant for transplant because data lives in these different hospitals, they live at the OPO, they live with these different Mendabice companies, they live with UNOS and the OPTN. But a lot of those systems don't actively talk to each other. But I think if we can kind of create a single data foundation where all this lives, and we can use that data foundation and point different artificial intelligence models at it, I think we'll be able to get a lot of interesting insights about what are the best pathways for care for this individual transplant patient. Because I think for a lot of technologies out there, there's general consensus that these improve patient outcomes, but we don't know for this specific person what is the best way to do things in the whole end-to-end process from organ recovery to post-transplant management to produce the longest, best outcome, highest quality of life for that particular person. And, you know, that's where the limitation of the human comes in, is it's impossible for us to digest and synthesize all that information, but artificial intelligence can. And I think we combine the ability of AI to look at that data set with humans' abilities to apply those insights to a system level, that I think gets really powerful. That is transformative, it's not incremental change, like that is a huge shift in how we do things. But we need to, you know, set the system up so that we can do that because right now, you know, we're not set up in that way. That's something that I think us, you know, we're driving towards. You know, that's when we talk about what we want to do in the future, like that's something that I think we're we're heavily looking into right now. It's like, how can we achieve that?
SPEAKER_01You've laid that out so clearly, and I can see it. I mean, we are all using AI in our own capacities, and I see AI almost as human augmentation, even in the clinical world. It can augment what we're doing. It can do those things that we might not be necessarily needed to do, but you can't do them without having that human in the loop. And that's where we come in with our expertise utilizing these data sets and utilizing machine learning and large language models. So it's going to be fascinating to see where this goes. And Devin, we're going to look forward to having you back in six months so we can chat more about what is happening in UNOS. Thank you so much.
SPEAKER_00Thank you. And I'm really excited for a follow up conversation because, as one of my colleagues says, at least on the AI front, today is going to be the worst it ever is. And it's only going to get better. So I always keep that in mind. And I think that can apply to a lot of things as well.
SPEAKER_01Oh, wonderful. Thank you.
SPEAKER_00Thank you, man. Appreciate it.