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A new  from the National Academies of Sciences, Engineering, and Medicine recommends changes to improve fairness, equity, transparency and cost-effectiveness in the U.S. organ transplant system. The report recommends that the Department of Health and Human Services develop national performance goals for the system, align payment and other policies to meet those goals, and achieve equity in the system in the next five years. It also calls for HHS to work with the Organ Procurement and Transplantation Network to develop standardized metrics to track performance, improve the policymaking process and reduce nonuse of deceased donor organs, among other actions.