How organs are matched to patients waiting for a life-saving transplant.
When a patient is accepted for placement on a transplant program's waiting list, they are registered with the Organ Procurement and Transplantation Network (OPTN). The OPTN is a centralized computer network linking all organ procurement organizations and transplant centers. The United Network for Organ Sharing (UNOS), an organization under contract with the federal government, maintains the OPTN. This computer network is accessible 24 hours a day, seven days a week.
When donor organs become available, the responsible organ procurement organization accesses the OPTN computer, which generates a list of patients ranked according to the OPTN policies on organ allocation. This organ sharing system took many years to develop. The system is constantly reevaluated and improvements are made when necessary to ensure that all potential transplant recipients have a fair and equitable chance to receive a donated organ.
For each organ that becomes available, the computer program generates a list of potential recipients ranked according to objective criteria (i.e. blood type, tissue type, size of the organ, medical urgency of the patient, time on the waiting list, and distance between donor and recipient). Each organ has its own specific criteria. Ethnicity, gender, religion, and financial status are not part of the computer matching system.
IOPO professionals contact potential transplant centers using an electronic process called DonorNet. Before DonorNet, over 200 phone calls were made to transplant centers to locate potential recipients. Now transplant centers know almost immediately of available organs. It saves valuable life-saving time! The transplant surgeon caring for the top-ranked patient (i.e. patient whose organ characteristics best match the donor organ and whose time on the waiting list, urgency status, and distance from the donor organ adhere to allocation policy) will evaluate the organ offers and make a decision appropriate for their waiting patient. Depending on various factors, such as the donor's medical history and the current health of the potential recipient, the transplant surgeon determines if the organ is suitable for the patient. If the organ is turned down, the next listed individual's transplant center is contacted, and so on, until the organ is placed.
Once the organ is accepted for a potential recipient, transportation arrangements are made for the surgical teams to come to the donor hospital and surgery is scheduled. For heart, lung, or liver transplantation, the recipient of the organ is identified prior to the organ recovery and called into the hospital where the transplant will occur to prepare for the surgery.
The recovered organs are stored in a cold organ preservation solution and transported from the donor to the recipient hospital. For heart and lung recipients, it is best to transplant the organ within six hours of organ recovery. Livers can be preserved up to 24 hours after recovery. For kidneys and typically the pancreas, laboratory tests designed to measure the compatibility between the donor organ and recipient are performed. A surgeon will not accept the organ if these tests show that the patient's immune system will reject the organ. Therefore, the recipient is usually not identified until after these organs are recovered.
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