Known, Preventable, and Still Occurring: The Ethical Case for a National Transplant Safety and Learning Network

Purpose of review: We examined voluntary safety reporting systems in high-reliability medical organizations to identify lessons applicable to the U.S. transplant system. Recent findings: Voluntary, non-punitive reporting systems substantially outperform regulatory oversight in capturing the near misses and low-frequency events that drive genuine learning. Enforcement authority and candid voluntary reporting exist in inherent tension — a condition that limits the U.S. transplant system's learning capacity not from any institutional failure, but from the nature of regulatory authority itself. Summary: We propose the Transplant Safety and Learning Network (TSLN), a federally listed Patient Safety Organization operating independently of enforcement structures, open to all members of the transplant team and the patients and families they serve. The TSLN would enable cross-institutional pattern detection for events invisible at the program level. Building it is not merely an operational opportunity — it is an ethical obligation.