Organ transport relies on commercial flights and couriers with no GPS tracking

Most donated organs in the US are transported via commercial airlines and ground couriers, not dedicated medical flights. An organ is packed in a cooler, handed to a courier, and sent on a commercial flight—subject to the same delays, cancellations, and mishandling as any other piece of cargo. There is no standardized GPS tracking system for organs in transit. A JAMA Network Open study found that increased transit time is directly associated with increased cold ischemia time in kidney transplantation, and cold ischemia time beyond 36 hours dramatically increases delayed graft function (from 20.9% at short CIT to 37.5% at long CIT). Approximately 3,280 deceased donor kidneys are discarded annually in the US, and extended cold ischemia from transport delays is a contributing factor. Hearts and lungs have only 4-6 hours of viable transport time, meaning a single flight delay can render an organ unusable. UNOS has been criticized for 'refusing to coordinate organ transport,' leaving logistics to individual OPOs and transplant centers. Some organizations like the United Therapeutics-backed company have begun developing drone delivery for organs, but these are pilot programs. The structural problem is that organ transport is not treated as the life-or-death logistics challenge it is—there is no national organ transport infrastructure, no dedicated fleet, and no real-time tracking mandate.