Katherine Screws lost her small intestine in a car crash in May 2022, just a month after her wedding, and spent the next three years tethered to an overnight IV drip waiting for a new one. The Phoenix woman's ordeal finally ended in June 2025 when she received a transplant at MedStar Georgetown University Hospital in Washington, D.C. — but only after nine separate donor offers made on her behalf in 2024 were all rejected by her transplant team.
A Crash That Changed Everything
The accident destroyed Screws' small intestine, the organ responsible for breaking down food and absorbing nutrients, according to ClickOnDetroit, which cited original Associated Press reporting by Lauran Neergaard. Dependent on intravenous nutrition to survive, Screws could not return to her engineering job and had to put on hold plans to start a family with her husband. She has described the wait as excruciating, saying the accident derailed her life.
Through 2024, the organ procurement organization OneLegacy made nine intestine offers on her behalf, and her transplant team turned down every one, per the same AP account. Frustrated, Screws began sending emotional letters to organ procurement organizations around the country, asking them to confirm their matching programs were properly searching for and prioritizing small intestine donations.
Doubling Her Odds by Double-Listing
Her breakthrough came after she double-listed at a second transplant center — MedStar Georgetown, a hospital that performs more small bowel transplants than almost any other program in the country. According to MedStar Health, the center maintains an average wait of 4.4 months for small bowel transplants, less than half the 11.2-month national average. Within weeks of double-listing, Screws received an offer from a donor in Chicago. The intestine was longer than what is usually transplanted, but it fit successfully.
Screws said organ selection involves far more subjectivity than she expected, noting that her new intestine was larger than average. Dr. Cal Matsumoto said organ availability ultimately depends on the right donor appearing at the right time, the AP reported. Screws added that her frustration was aimed at the system's lack of centralized, understandable information rather than at her own doctors — she said she wished patients had more clarity about when a matching organ might become available and why a given one was not a match, and that she should have asked sooner what was holding up the process.
UCLA Health declined to comment on Screws' case, citing patient privacy rules, but said it follows federal transplant guidelines and that its transplant teams continuously strive to enhance patient-service processes, according to the AP account.
How the National Matching System Actually Works
Transplant centers maintain organ-specific waiting lists linked to a nationwide automated matching system. When an organ procurement organization identifies a donor organ deemed suitable for use, the matching system generates ordered lists of possible recipients across multiple hospitals. A transplant surgeon may layer on additional requirements — a donor age under 40, for instance — and transplant teams then weigh lab tests, scans and medical records before accepting or declining an offer. A declined offer simply moves to the next hospital in line. Because organs vary in how long they can last outside the body, distance factors heavily into matching, and surgeons sometimes travel to personally retrieve organs that are difficult to handle; recovering an intestine in particular requires surgeons to negotiate the division of blood vessels shared with nearby abdominal organs.
That subjectivity extends well beyond intestines. A study published last year found that kidney patients who died on waiting lists had a median of 25 declined organ offers, even though many of those declined kidneys were eventually used by other recipients. Dr. Syed Ali Husain, who researches differences in kidney transplant-center outcomes, said some surgeons have far greater experience using kidneys with complex anatomy or kidneys from older, sicker donors — meaning the same organ might be rejected at one hospital and accepted at the next. A separate study in Frontiers in Transplantation found that roughly 30% of waitlisted kidney candidates with at least one declined deceased-donor offer eventually died or were removed from the list without ever receiving a transplant.
Why Intestine Transplants Remain So Rare
Intestine transplants are among the rarest solid-organ procedures in the country. Just 88 were performed in the U.S. last year, compared with more than 27,000 kidney transplants and just over 49,000 total transplants nationwide, per the AP's reporting. About 100,000 people are currently awaiting a transplant, most of them needing a kidney. Annual intestine transplants peaked in 2007 before falling to a historic low of 81 in 2019, a decline driven mainly by advances in intestinal rehabilitation that have allowed many patients on IV nutrition to avoid surgery altogether, according to HRSA's Scientific Registry of Transplant Recipients data. The same registry reports that 128 new candidates joined the intestine waiting list in 2024, and candidates awaiting an intestine transplant without a liver recorded zero waitlist deaths for a second consecutive year — though those needing a combined intestine-liver transplant still face close to 15% mortality within three years.
Lisa Stocks showed Screws transplant data from the Scientific Registry of Transplant Recipients, an online database that lets patients compare wait times and other characteristics across transplant hospitals. Dr. Allyson Hart, who helped design tools for a more patient-friendly version of that database, said many patients mistakenly believe that waiting five years guarantees they will eventually receive a transplant — an assumption the data does not support.
A System Under Federal Pressure
The gaps Screws encountered are playing out against a backdrop of sweeping federal reform. Deceased-donor donations have risen steadily for more than a decade, yet roughly one in five donated organs still goes unused nationwide, largely because a recipient was not found in time, the AP reported. A study cited by the Organ Donation Alliance found that 17.3% of procured U.S. kidneys were discarded over 2000–2015. A large study has also found that kidney transplant speed can vary roughly 16-fold depending on which transplant center a patient uses.
The federal government has pursued an overhaul of the organ procurement and transplantation network. The U.S. has 55 organ procurement organizations, and a pending federal grading system — built on the Centers for Medicare & Medicaid Services' 2020 OPO Final Rule evaluating age-adjusted transplantation rates — could force some of them to close based on how many organs they actually procure and get transplanted. OneLegacy and other OPOs are among those that have joined lawsuits seeking to block such closures.
Separately, Medicare is running a pilot project testing financial incentives and penalties meant to encourage hospitals to perform more kidney transplants and cut down on organ waste.
Screws' story illustrates how uneven and surgeon-dependent organ matching can be. For Screws, the lesson was less about blame than about information: she has said what she wanted most, throughout three years of waiting, was simply a clearer picture of why a match wasn't happening and when one might.
