The dispute between Buckeye Transplant Services and the United Network for Organ Sharing was a 2023 fight over whether a private vendor could pull data from the national organ matching system using an automated tool, and it briefly raised the possibility that dozens of transplant centers would lose the screening support they relied on to evaluate organ offers in time. The Buckeye-UNOS organ transplant dispute was resolved through private arbitration within days of being filed in federal court, and no transplant program lost access to organ offers while it played out.
Who the Two Sides Were
UNOS held the sole federal contract to operate the Organ Procurement and Transplantation Network and run DonorNet, the computerized system that matches donors with recipients. That contract made UNOS responsible for protecting the sensitive donor and recipient data moving through the system and for enforcing the rules governing who could access it.
Buckeye Transplant Services is a private company that contracts with transplant centers to handle organ screening and evaluation. When an offer comes through DonorNet, Buckeye staff rapidly assess whether the organ is suitable for a particular patient, sparing hospital transplant teams from fielding every offer themselves. Buckeye describes itself as the largest provider of transplant support services in North America and later merged with a company called Afflo in 2025.
Sitting above both was the Health Resources and Services Administration (HRSA), the federal agency overseeing the OPTN and ultimately responsible for ensuring that no transplant program lost access to organ offers no matter how the fight resolved.
What the Fight Was About
UNOS alleged that Buckeye used an automated tool to extract data from DonorNet rather than going through the standard authorized channels. From UNOS’s perspective, that was a data security problem: the matching system contains protected health information, and any unauthorized retrieval method creates risks of exposure or misuse. UNOS argued that third-party vendors working on behalf of hospitals had to follow the same access rules as every other OPTN member.
Buckeye saw it differently. The company argued that the post-transplant data it retrieved belonged to the hospitals it served, not to UNOS, and that its retrieval methods did not violate any applicable law. Its lawsuit alleged that UNOS had misinterpreted its own Systems Terms of Use and that Buckeye was entitled to unrestricted access to OPTN data once its hospital clients authorized it.1United Network for Organ Sharing. Statement Concerning Buckeye Transplant Services
Underneath the contract language was a question the transplant world had not been forced to answer before: when a vendor accesses the system on a hospital’s behalf, who owns the data, and what retrieval methods are allowed?
Why a Cutoff Would Have Mattered for Patients
UNOS threatened to cut off Buckeye’s access to DonorNet entirely. If that had happened, every transplant center relying on Buckeye to screen organ offers would have needed to absorb that work with their own staff on no notice.
Organ evaluation is time-sensitive. A heart must be transplanted within roughly four to six hours of recovery. Kidneys tolerate more time but degrade significantly after 24 hours outside the body. Livers fall somewhere in between. Every delay in evaluating and accepting an organ pushes closer to the window where the organ becomes unusable, and transplant centers are not staffed to swallow a sudden influx of screening work. The realistic consequence of an abrupt cutoff would have been longer evaluation times, more declined offers, and more organs discarded because they sat too long.
How It Ended
Buckeye filed a federal lawsuit on July 3, 2023, with an emergency motion for a temporary restraining order to block UNOS from cutting access.2CourtListener. Buckeye Transplant Services, LLC v. United Network for Organ Sharing (3:23-cv-00427) UNOS agreed to hold off for at least two weeks while the court considered the request.1United Network for Organ Sharing. Statement Concerning Buckeye Transplant Services Before the court could rule, Buckeye voluntarily dismissed the lawsuit in favor of binding arbitration. The case was terminated on July 10, 2023, barely a week after it was filed.
The move to arbitration took the substantive dispute out of public view. UNOS said that regardless of the outcome, no transplant program would experience interruptions in receiving organ offers.1United Network for Organ Sharing. Statement Concerning Buckeye Transplant Services The terms of the arbitration resolution have not been publicly disclosed. Buckeye kept operating.
What Changed After the Dispute
The episode fed into a broader federal push to break up the single-contractor arrangement that had put UNOS in sole control of the matching system. Congress passed the Securing the U.S. Organ Procurement and Transplantation Network Act, which authorized HRSA to award multiple grants, contracts, or cooperative agreements to run the OPTN instead of relying on one organization.3Congress.gov. HR 2544 – Securing the US Organ Procurement and Transplantation Network Act
HRSA moved on it. By September 2024, the agency had awarded modernization contracts to multiple vendors covering patient safety oversight, IT system modernization, policy transparency, patient communications, and financial management.4Health Resources and Services Administration. HRSA Makes Multi-Vendor Modernization Awards to Support the OPTN UNOS kept a contract to continue operating the national matching system itself, with several of its historical functions being competitively awarded to new vendors in 2026.5Health Resources & Services Administration. A Year in Review: Advancing OPTN Modernization and Strengthening the National Transplant System
HRSA has also proposed tightening data access rules directly. Under the proposal, every third-party vendor accessing the OPTN computer system through a member hospital would have to execute an Interconnection Security Agreement with the OPTN and follow the same information security requirements as any other member. Access would be limited to three purposes: facilitating transplantation, fulfilling OPTN obligations, and quality improvement.6Health Resources and Services Administration. Revise Conditions for Access to the OPTN Computer System Had those rules been in place in 2023, the ambiguity that drove the Buckeye dispute would have been far narrower, and the question of what a vendor can do with OPTN data would have had a regulatory answer instead of hinging on a contract fight between two private entities.