When transplant hospitals accept patients onto the waiting list, the patients are registered in a centralized, national computer network that links all donors and transplant candidates. The UNOS Organ Center is staffed 24 hours a day throughout the year, and it assists with the matching, sharing and transportation of organs via this computer network.
Transplant centers, tissue typing laboratories, and OPOs are involved in the organ sharing process. When donor organs are identified, the procuring organization typically accesses the computerized organ matching system, enters information about the donor organs, and runs the match program. At times, when requested or when there is a need to identify perfectly matched kidney donor/recipients, the matching process is handled by Organ Center personnel at UNOS headquarters in Richmond, Virginia.
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.
After printing the list of potential recipients, the procurement coordinator contacts 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) to offer the organ. 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.
Organ Procurement Organizations (OPOs)
The role of the organ procurement organization (OPO) is very important in the matching process. OPOs become involved when a patient is identified as a potential donor. The OPO coordinates the logistics between the organ donor's family, the donor organs, the transplant center(s), and the potential transplant candidate.
OPOs provide organ recovery services to hospitals located within designated geographical area of the U.S. OPOs are non-profit organizations and, like transplant hospitals, are members of the OPTN. Each has its own board of directors and a medical director on staff who is usually a transplant surgeon or physician.
OPOs employ highly trained professionals called procurement coordinators who carry out the organization's mission. Once contacted by the hospital with a potential donor, OPO staff:
- Conduct a thorough medical and social history of the potential donor to help determine the suitability of organs for transplantation
- Work with hospital staff to offer the option of donation to the donor family
- Ensure that the decision to donate is based on informed consent
- Manage the clinical care of the donor once consent for donation is finalized
- Enter the donor information into the UNOS computer to find a match for the donated organs
- Coordinate the organ recovery process with the surgical teams and provide follow-up information to the donor family and involved hospital staff regarding the outcome of the donations
From the moment of consent for donation to the release of the donor's body to the morgue, all costs associated with the organ donation process are billed directly to the OPO.
OPOs also promote organ donation in their community by sponsoring workshops on organ donation and participating in community health fairs and events. OPO hospital development coordinators also work with hospitals to help educate the staff on the donation process and care of the donor family. To find out about the OPO in your area, go to the Member Directory