New transplant network fees could strain rural organ procurement organizations
H.R. 5259 — Permanent OPTN Fee Authority Act · Filed by Jim Costa (D-CA) · 1 cosponsor · Introduced Sep 10, 2025 · Referred to committee
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What it does
This bill authorizes the Secretary of Health and Human Services to collect registration fees from members of the Organ Procurement and Transplantation Network (OPTN) based on the number of transplant candidates each member places on the waiting list. The fees collected must be used only to support OPTN operations, with transparency requirements mandating quarterly public reporting of fees collected from each member and how the fees are spent. A Government Accountability Office review is required within 2 years.
Why we flagged it
The bill establishes a new fee-collection authority for a specific healthcare network rather than creating a new program or restricting existing ones. It is primarily a fiscal/administrative mechanism to fund existing OPTN operations through member fees.
What the text implies
- Fee structure based on transplant candidates placed (not transplants performed) may incentivize listing practices that increase OPTN workload without corresponding transplant outcomes, potentially straining system resources.
- No fee cap or sliding scale is specified, creating risk that smaller or rural organ procurement organizations face disproportionate cost burden relative to larger urban networks, potentially reducing geographic equity in transplant access.
- Fees are 'discretionary offsetting collections' credited to HHS appropriations, meaning they may reduce future Congressional appropriations for OPTN rather than supplementing existing funding—a hidden budget mechanism.
- The bill requires quarterly transparency reporting but does not mandate public comparison of fees collected versus services delivered, limiting meaningful accountability despite reporting requirements.
- GAO review is required only 'to the extent data are available,' creating a loophole that may allow incomplete or delayed oversight if OPTN claims data limitations.
Section numbers refer to the bill text the analysis read — linked under Primary records below.
Who it affects
The bill creates a new funding mechanism for OPTN operations that could improve transplant system efficiency and transparency through required public reporting and GAO oversight. However, the fee structure may increase costs for organ procurement organizations, which could indirectly affect transplant access or availability if organizations pass costs to hospitals or reduce services; the bill does not cap fees or establish affordability protections for smaller or rural procurement organizations.
Who stands to gain
- Organ Procurement Organizations (OPOs)
- Transplant centers and hospitals (as OPTN members)
- OPTN administrative operations
Named in the bill
Organ Procurement and Transplantation Network (OPTN), Secretary of Health and Human Services, Department of Health and Human Services, Government Accountability Office (GAO), House Committee on Energy and Commerce, Senate Committee on Health, Education, Labor, and Pensions, Senate Committee on Finance
Where it stands
1 cosponsor: 1 Republicans.
- Sep 10, 2025 — Introduced · Congress.gov: “Introduced in House”
- Sep 10, 2025 — Referred to House Committee on Energy and Commerce · Congress.gov: “Referred to the House Committee on Energy and Commerce”
Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.
Money around this bill
2 lobbying clients named this bill on 3 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $470,000 in lobbying spend. A filing names 10 bills on average, so that figure is what each filing reported, not a share belonging to this bill.
More lobbying clients named this bill than 41% of bills with at least one filing.
Jim Costa, the sponsor, reported $855,144 in PAC receipts in the 2026 cycle.
- American Kidney Fund — $410,000 on 2 filings
- Mayo Collaborative Services, Inc. — $60,000 on 1 filing
Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.
How this was measured
Analysis — Quorum's AI read the bill text published by Congress.gov (2,937 characters) on Aug 21, 2026. Section numbers in the findings refer to that text, linked below; transparency and hidden-provision scores are compared against the median of 16,222 analysed bills.
Status and sponsors — Congress.gov's bill record — actions, committee referrals and cosponsors — loaded nightly. The timeline shows status changes, not every procedural action.
Money — Senate Lobbying Disclosure Act filings whose specific-issue field names this bill for quarters ending Dec 2025 to Jun 2026. A filing's amount is reported whole beside the median number of bills a filing names; it is never divided across them. PAC receipts are FEC-reported contributions to the sponsor's candidate committee in the 2026 cycle.
As of — lobbying records through Jul 20, 2026 · page rendered 2026-10-20.
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