The Organ Procurement and Transplant Network declined to make officials available for interviews. In a written statement, network President Dianne LaPointe Rudow said patients with blood type O were not skipped entirely, saying some “still received transplants and recipients received lungs from donors of compatible blood types.”

In response to written questions about the number of patients harmed by the error, the network said “it is not possible to accurately predict the number of patients that would have received a transplant or would have lived or died based on a certain policy because there are a variety of dynamic factors that contribute to a person receiving a transplant that vary per each unique organ, including the characteristics of a donated organ (such as blood type, size, disease history), a transplant center’s acceptance of an individual organ for their patient, a waiting list that’s always being updated.”

Asked to explain what went wrong with its algorithm, network officials said the modeling used to predict outcomes made a basic scientific error by assuming recipients could receive lungs from donors of any blood type.

“While evaluating why actual transplant volume for blood type O recipients did not match the modeling results, it was determined that the modeling overestimated blood type O transplant rates because the simulation allowed for recipients to receive lungs from donors of any blood type, regardless of compatibility,” the network said.

In the real world, no patients were given organs of the wrong blood type, as numerous safeguards exist to protect against such a mismatch. But blood type O patients were effectively deprioritized under the new system, causing them to receive fewer lung transplants.

‘Hidden in plain sight’

The changes to the transplant algorithms, which were years in the making, underscore the thorny questions the organization faces as it supervises the distribution of vital organs.

Determining who gets available donor organs is governed by a formula based on factors including someone’s level of need, likelihood of survival, biological aspects such as blood type or height, patient access to transplant centers, and efficiency, which includes logistics and distance.

In recent years, the Organ Procurement and Transplant Network has grappled with geography as a factor in patient care and sought to move away from hard rules based on distance. Under previous models, a patient whose medical urgency was low but who lived closer to a donor hospital than someone who needs the donated organ more could take priority over the sicker person, the network said.

“Geography presents inherent challenges in developing equitable transplant policy for candidates across the nation,” the former president of the OPTN/UNOS board of directors, Yolanda Becker, said at the time. “There are differences in the distribution of transplant centers and in the size and configuration of organ procurement organizations. In addition, there is geographic variability in the concentration of disease patterns that cause organ failure and causes of death that make organ donation possible.”

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