“Active” or “Inactive” Organ Transplant List Status: A Matter of Life or Death
Negligence by transplant centers that place or leave patients in “inactive” status can deprive patients of transplant opportunities and may ultimately cost lives.
On an organ-transplant waiting list, status is everything. A patient designated as “inactive” remains nominally listed, but in practical terms receives no organ offers and may lose valuable waiting-time priority. In a time-sensitive transplant system, an erroneous or prolonged inactive designation can mean the difference between life and death. Transplant centers face increasing liability exposure when patients remain inactive due to negligence rather than medical necessity.
Under rules administered by the United Network for Organ Sharing and the Organ Procurement and Transplantation Network (UNOS/OPTN), transplant centers exercise exclusive control over whether a patient is eligible to receive organ offers. Patients cannot reactivate themselves, cannot directly correct database errors, and often have limited visibility into how their status is being managed. Courts increasingly recognize that this degree of control carries a corresponding legal responsibility.
Transplant centers owe patients a duty not only to exercise sound medical judgment, but also to competently manage waitlist status. That duty includes timely eligibility review, accurate data entry, proper documentation, and clear communication regarding changes that affect transplant access.
Patients may be placed or left in inactive status because test results were overlooked, insurance approvals were mishandled, eligibility criteria were improperly applied, or resolved medical conditions were never reevaluated. In many of these situations, the problem is not medical judgment but administrative or systems failure. In some cases, fully eligible patients are never activated at all due to simple clerical errors.
Legal liability may arise under traditional medical-negligence principles when reactivation should have occurred under accepted transplant standards. Liability may also arise under ordinary negligence theories when the failure is administrative or clerical in nature, such as data-entry errors, missed alerts, or breakdowns in internal communication. Courts are often unreceptive to arguments that such errors are protected by professional discretion when the conduct at issue resembles recordkeeping rather than clinical decision-making.
One of the most vulnerable areas for transplant centers is failure to inform patients of their status. Many patients are never clearly told they have been placed in inactive status. Others are told they remain “on the list” without explanation of the consequences, or are not informed of the steps required for reactivation. Because inactive status directly affects access to a lifesaving intervention, nondisclosure may support claims based on lack of informed consent, negligent misrepresentation, or omission of material facts.
When a patient dies while improperly inactive, causation becomes the central legal issue. Transplant centers often argue that it cannot be proven that the patient would have received an organ even if active. Tort law, however, does not require certainty. Plaintiffs may rely on organ-offer data, comparative waitlist outcomes, and statistical modeling to demonstrate that negligent inactivity materially reduced the patient’s chance of survival. These cases are commonly described as “loss-of-chance” claims.
Regulatory standards reinforce these claims. Policies promulgated through the Organ Procurement and Transplantation Network and oversight by the Health Resources and Services Administration do not automatically establish liability, but they provide important evidence of the standard of care. Failures to review inactive status, document decisions, or notify patients may strongly support negligence claims, particularly where electronic records reveal long periods of unjustified inactivity.
Congressional testimony has also highlighted deficiencies in patient notification. Although patients are theoretically supposed to receive written notice of status changes, in practice that notification requirement is often inconsistently followed.
From a litigation standpoint, these cases are often difficult to defend. The factual narratives are compelling, the errors are easy for jurors to understand, and electronic audit trails frequently show when a patient should have been reactivated but was not. As public and regulatory scrutiny of transplant-list integrity continues to increase, negligent management of inactive status is emerging as a significant and underrecognized source of liability.
Transplant centers must ensure that reliable systems exist to accurately record eligibility and notify patients of status changes. UNOS databases and transplant-center electronic systems do not always communicate seamlessly, and existing safeguards may not prevent clerical or administrative errors.
The takeaway is straightforward: transplant centers are not merely caretakers of a waiting list. They are gatekeepers to lifesaving treatment. When patients are left inactive due to preventable error or poor communication, traditional negligence principles apply — and courts are increasingly willing to enforce them.
If you or someone you know was waiting for an organ transplant and later discovered that they were listed as inactive — particularly if they were told they were active or eligible for transplant — you may not be alone. Improper inactive status may prevent patients from receiving organ offers and can have devastating consequences.
If you believe you or a loved one may have been affected by inactive transplant waiting list status, our office welcomes the opportunity to speak with you and review the circumstances. Call Ed White Law to discuss your case with someone willing to listen.