Because of the organ shortage, the process of managing and distributing the organs that are available is complex and often surrounded by controversy. This section provides an overview of the way organs are currently allocated, with an emphasis on the procedures affecting the Washington metropolitan area.

Many people believe that there is one national waiting list for each organ, and that the next available organ goes to the person at the top of the list. That isn’t the situation for many reasons. There is a national waiting list, but it is secondary to the local lists.

As the federal Organ Procurement and Transplantation Network (OPTN) operations contractor, the United Network for Organ Sharing (UNOS) is charged with the task of facilitating the equitable distribution of organs. For the purposes of managing organ allocation, UNOS oversees approximately 64 organ procurement organizations (OPOs) that service one or more of the 279 transplant centers. The OPTN (UNOS) maintains a list of transplant candidates by OPO. Typically, there is one list per organ per OPO, but variations do exist, particularly for kidney patients. When an organ is recovered by an OPO, it goes to the highest ranking patient on that OPO’s list. If there is no patient within the OPO that is a good match, the OPO contacts UNOS, which refers to the national list. Distance is then a factor in allocating the organ, as transit time limits the practical shipping distance, especially for hearts and lungs.

Maximum organ preservation times are:
 

The times shown above are from the time the organ is "harvested" until the time it is transplanted with blood flow in the recipient.

All patients accepted onto a transplant program’s waiting list for transplantation are registered with UNOS. UNOS maintains a centralized computer network linking all organ procurement organizations and transplant centers. This computer network is accessible 24 hours per day, seven days per week, with organ placement specialists always available to answer questions.

When a donor becomes available, the organ procurement organization (OPO) will access the UNOS computer, which generates a list of patients ranked according to the UNOS policies on organ allocation for that particular donor. Each donor will generate a different list of potential recipients.

Why might the patient who appears first on the waiting list not get an organ? To answer this question, it is important to understand how organs are allocated. When a patient’s name is "added to the list." his or her medical profile is entered and stored in the UNOS computer. The patient is not placed on a ranked list at that time. Rather, the patient’s name is added to the "pool" of patient names. When an organ donor becomes available, each patient in this "pool" is matched by the computer against the donor characteristics. This includes size and blood type. The computer then generates a list of patients ranked in order based upon medical and scientific criteria comparing all patients in the pool to that particular donor. Time on the list is one factor in the ranking.

The list is accessed first for potential recipients at centers within the local area of the donor hospital. If no matches are found, the search is broadened to a larger region of the country and then nationwide if necessary. Factors affecting ranking include blood type and size, and may include tissue match, length of time on the waiting list and immune status. For heart, liver, and intestinal organs, the potential recipient’s degree of medical urgency is also highly considered. Therefore each donor will generate a differently ranked list of patients.

After receiving a printout of the waiting list, the transplant coordinator contacts the transplant team of surgeons and physicians for selection of a patient using the ranking list. Sometimes the top patient will not get the organ for one of several reasons. When a patient is selected, he or she must be available, healthy enough to undergo major surgery and willing to be transplanted immediately. Also, a laboratory test to measure compatibility between donor and recipient may be necessary. For example, patients with high antibody levels often prove incompatible to the donor organ and cannot receive the organ because the patient’s immune system would attack and reject it immediately.

Once the patient is selected and contacted and all testing is complete, surgery is scheduled and transplantation takes place, now!

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The National Organ Transplant Act of 1984 established a task force that examined the issues related to organ procurement and transplantation. In 1986, the task force issued its report with recommendations for dealing with these issues on a national, state and local level.

Since 1986, the United Network for Organ Sharing (UNOS) has administered the national Organ Procurement and Transplantation Network (OPTN) and the U.S. Scientific Registry on Organ Transplantation under contracts with the U.S. Department of Health and Human Services. UNOS is responsible for promoting, facilitating and scientifically advancing organ procurement and transplantation throughout the United States while administering a national organ allocation system based on scientific and medical factors and practices.

UNOS members include every transplant program, organ procurement organization (OPO) and tissue typing laboratory (TTL) in the United States. Policies governing the transplant community are developed by the UNOS membership through a series of regional and national meetings, with final approval by a 32 member board of directors consists of physicians and non-physicians.

UNOS has formulated policies to strive for equitable organ allocation to patients registered on the national waiting list. These policies are based on medical and scientific criteria. They forbid favoritism based upon political influence, race, sex or financial status. However, because of the shortage of organs, allocation policies are subject to intense scrutiny and sometimes, emotional criticism from various groups whose members might be affected by policy changes. The task of "equitable" allocation can be exceedingly difficult. UNOS is charged with the task of supervising the equitable distribution of organs. UNOS oversees approximately 64 independent OPOs and 54 independent TTLs that service one or more transplant centers for the purpose of managing organ allocation. Each OPO maintains a list of transplant candidates within its regional boundaries. When there is not a suitable recipient for a particular organ in the local region, a search is made of adjacent regions until a suitable recipient is located.

United Network for Organ Sharing
1100 Boulders Parkway
Suite 500
PO Box 13770
Richmond, VA 23225-8770
800-24-DONOR / (800-243-6667) 804-330-8500 FAX 804-330-8517 & -8593
http://www.unos.org

UNOS Statistics. The UNOS national patient pool for organ transplant contains over 50,000 registrations. A new name is added every 18 minutes. There is a severe shortage of transplantable organs and the waiting list grows each day. The statistics shown here will be out of date by the time you read them.

As of March 29, 1997, there were registrations for:

National Registrations
 

Washington Metropolitan Area Registrations
 

Note: UNOS policy allows patients to be listed with more than one transplant center (multiple listing), and thus the number of registrations may be greater than the actual number of patients.

Number of Transplants Performed, January - December, 1995
 

In addition, there were almost 45,000 corneal transplants. Based on UNOS Scientific Registry data as of April 6, 1995. Double kidney, double lung, heart-lung and kidney-pancreas transplants are counted as one transplant.

During 1995 a recipient received his or her organ transplant every 27 minutes, and still over 3600 died because they did not receive a transplant in time to save their lives.

Currently, 279 medical institutions in the United States operate an organ transplant program. These transplant centers can be classified by organ specific programs that include the following: