Arizona woman's 3-year wait for an intestine shows the US organ
transplant system's complexity
[October 20, 2026]
By LAURAN NEERGAARD
A car crash destroyed Katherine Screws’ small intestine, leaving her
unable to eat, dependent on IV nutrition and often too sick to get out
of bed. But the Phoenix woman clung to her hospital’s prediction that
she could get an intestine transplant in about six months.
That was way off. She wouldn’t get one until three years after the
crash.
It could have been longer if not for an unusual meeting with an organ
procurement organization, or OPO, that taught the frustrated Screws how
hospitals vary in which organs they accept or refuse — and she flew
across the country for a better chance.
“I wish that there was more clarity with patients about when is an organ
coming up that could be a match for you and why is it not a match,” said
Screws, who received a transplant at her new hospital in just weeks. She
wishes she had asked sooner, “What is the thing that’s holding this up?”
Screws’ journey shows how the transplant system often struggles to
inform patients about options that can be incredibly difficult to
navigate on their own. Among them are where to seek care, whether to get
on multiple hospitals’ transplant lists, and how to discuss if you’d
accept a less-than-perfect organ rather than continue waiting. And in
the background, viable organs can be wasted. About 1 in 5 donated organs
go unused, usually because a recipient wasn’t found in time.
For kidney transplants, the most common type, a large study found
"there’s about a 16-fold variation in how quickly a patient will get
transplanted at one center versus another,” said Dr. Syed Ali Husain of
NYU Langone Health, who researches such differences.
One reason is that some surgeons have more experience than others using
kidneys with complex anatomy like extra arteries, or those from older,
sicker donors that still may be better than dialysis for the right
patient, he said.
There’s far less information about rare types of transplants like the
intestine, which is biologically more difficult to handle than some
other organs.
“We offer them but they’re declined so often that it’s demoralizing,”
said Lisa Stocks of California’s OneLegacy, one of the nation’s largest
OPOs, who showed the data to Screws.
Screws was one of just 88 people in the U.S. to receive a new intestine
last year, compared with more than 27,000 kidney transplants.
Whatever the organ, most patients don’t know what to ask, said Dr.
Allyson Hart of Minnesota’s Hennepin Healthcare Research Institute. She
helped design tools for a new patient-friendly online database that can
help people compare waiting times and other characteristics of different
transplant hospitals.
Too many patients think “they just needed to wait for five years and
they would get transplanted,” Hart said, when often “that’s actually not
what happens.”
Transplants are on the rise
With just over 49,000 transplants performed in the U.S. last year, more
people than ever are getting new organs. That’s mostly thanks to over a
decade of increases in donations from the deceased, recovered by OPOs
that act as a bridge to transplant hospitals.
But about 100,000 people are awaiting a transplant, the vast majority of
whom need a kidney. There’s growing pressure to retrieve and use more
donated organs, even as donor registrations recently dipped and an aging
population means organs increasingly come from older, sicker donors. And
the government is in the midst of a yearslong overhaul of the transplant
system.
One pending move threatens to close some of the nation's 55 OPOs under a
controversial grading system that holds them accountable for the number
of organs they procure and how many are transplanted — the latter, they
argue, being out of their control because surgeons decide when an organ
is right for their patient. Some, including OneLegacy, are part of
lawsuits seeking to block such closures.
Regulators also grade hospitals, and Husain said some of the reluctance
to use less-than-perfect organs has long stemmed from concern about
getting a lower score if even a few of them fail.
Medicare is running a pilot project to see if financial incentives or
penalties will push hospitals to perform more kidney transplants, so
fewer of those donated organs go to waste.
A foodie who could no longer eat
In late 2024, OPOs around the country began receiving emotional letters
from Screws and some of her family members. They detailed how a May 2022
car crash, a month after her wedding, required the removal of Screws'
small intestine, the organ that breaks down food and absorbs nutrients.
The self-described “passionate foodie” who loves to cook now got all her
nutrition from an overnight IV drip that left her severely nauseous and
unable to return to her engineering job or pursue plans with her husband
to start a family.
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In this photo provided by Katherine Screws, Screws poses in the
pre-op room with her husband, Stephen Gerrish, before her intestine
transplant surgery at MedStar Georgetown University Hospital, June
1, 2025, in Washington. (Katherine Screws via AP)
 “This accident completely derailed
my life and the wait for a new organ has been excruciating,” wrote
Screws, adding that her original transplant doctors “feel that it is
possible there is a lack of awareness of small bowel transplant
among organ procurement organizations.” She asked that the OPOs
“confirm your organization’s matching programs are properly
searching for and prioritizing small intestine donations.”
To OPOs required to recover as many organs as possible, it was a
shocking question. They work closely with grieving relatives of
deceased donors but seldom get questions from would-be recipients.
Stocks, the OneLegacy nurse, realized OPOs have data that could help
patients advocate for themselves, and started combing records.
How are donated organs retrieved and distributed?
Every transplant center has its own organ-specific waiting list
linked to a nationwide automated matching system. The OPO in charge
of each deceased donor enters information about organs deemed
suitable for use, which generates lists of possible matches at
multiple hospitals in order of priority. A patient who matches
baseline biological characteristics still might not show up as a
candidate if the surgeon added some additional requirements, such as
wanting a donor to be younger than 40.
Transplant teams must quickly decide on an offer, based on lab
tests, scans and other medical records. If they decline, the organ
then is offered to the hospital with the next-in-line possible
match.
“It’s the right donor at the right time. You can never predict these
things,” said Dr. Cal Matsumoto at MedStar Georgetown University
Hospital in Washington, the second transplant center where Screws
registered, and where she wound up getting a new intestine.
Matching begins before surgery to recover the organs, and distance
also plays a role, as some organs last longer than others outside
the body. Oftentimes, surgeons travel to personally remove certain
tricky-to-handle organs rather than relying on a local surgeon to
retrieve and ship them.
“Generally if it’s a very good donor, so to speak, there’s going to
be a heart team, a lung team, a pancreas team and a liver team, so
there’s a lot of coordination” even to schedule recovery, said
Matsumoto. For intestines, he said, that also involves surgeons
negotiating how they’ll divide critical blood vessels shared by
nearby abdominal organs.
But the process is far from perfect: In a study published last year,
a group of kidney patients who died on the waiting list had a median
of 25 organ offers their transplant team had declined — organs that
were eventually used in someone else.
An intestine with a quirk that’s working well
It turned out that Screws' local OPO, OneLegacy, had made nine
offers for her during 2024 that were all rejected. Stocks said she
had “candid conversations” with the transplant team about why they
were declined, such as technical preferences about the retrieval, so
she'd know better how to evaluate potential new donors.
Meanwhile, Stocks also showed Screws how to use a database run by
the Scientific Registry of Transplant Recipients to decide whether
to also seek care at a hospital that does more intestine
transplants.
In June 2025, just a few weeks after “double listing,” Screws
received a new intestine at Georgetown. It came, she learned, from a
donor in Chicago. It was longer than is usually transplanted, but
Matsumoto said it wound up fitting fine.
Screws’ original hospital, UCLA Health, cited patient privacy rules
in declining to comment except to say that it follows federal
transplant guidelines and that its transplant teams “continuously
strive to enhance processes in service to our patients.” While its
intestine program is small, UCLA is a major provider of kidney and
other transplants.
Screws is careful to say her frustration wasn’t with her doctors,
but with the lack of centralized, easy-to-understand information
about what to expect. She had never heard of OPOs until her
transplant coordinator mentioned them or realized there had to be a
bridge between donors and transplant surgeons.
“My main takeaway was that there is more subjectivity to selecting
an organ than I would have previously thought,” Screws said. Hers
was “larger than average and maybe another surgeon wouldn’t have
accepted that.”
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