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​​Modify Effect of Acceptance Policy​

eye iconAt a glance

Current policy

When allocating multiple organs from a single donor, there are times when all the organs are accepted by candidates who only need one organ. Occasionally, one of the accepted organs is declined, for a variety of reasons, and the next candidate on the match run requires more than one organ. At that time, the other required organ has been accepted by another candidate, so the organ procurement organization (OPO) does not have both organs to offer the multi-organ candidate. OPTN Policy does not currently address such situations, which can lead to confusion among OPOs and transplant programs and slow down the allocation process. The Committee is proposing adding clarifying language to policy to address this type of situation.

Supporting media

View presentation PDF link

Proposed changes

  • Clarify in OPTN Policy that an organ offer acceptance takes priority over a multi-organ offer if one of the required multi-organs has already been accepted by a single organ candidate.
    • For example, a donor heart has been accepted by a heart candidate and both donor kidneys have been accepted by two kidney candidates. If the heart candidate declines the heart, and the next candidate on the heart match run needs both a heart and a kidney, the OPO offering the organs is not required to offer both organs to the heart/kidney candidate since the kidneys have already been accepted by other candidates.

Anticipated impact

  • What it's expected to do
    • Improve organ allocation efficiency
      • Decrease confusion when an organ is declined
      • Provide clarity on the order of allocation
    • Improve equity in multi-organ allocation

Terms to know

  • Multi-Organ Candidate: A candidate registered on the waiting lists for more than one organ type.
  • Single Organ Candidate: A candidate registered on the waiting list for one organ type.
  • Match Run: A computerized ranking of transplant candidates based upon donor and candidate medical compatibility and criteria defined in OPTN policies.
  • Offer Acceptance: When the transplant hospital notifies the host OPO that it accepts the organ offer for an intended recipient, pending review of organ anatomy.

Click here to search the OPTN glossary


Read the full proposal (PDF)

Provide feedback

eye iconComments

Lilli | 02/20/2024

It is my opinion that priority for an organ should go to the already accepted patient in these instances. I believe this will allow for equitable organ allocation and efficient organ placement. Waiting to verify that there is no refusal slows down the time-sensitive transplant process for those who have accepted an organ. It does not seem ethical to rescind an offer once it has been accepted.

OPTN Organ Procurement Organization Committee | 02/20/2024

The OPTN Organ Procurement Organization (OPO) Committee thanks the Multi-Organ Transplantation Committee for their work on this proposal and the opportunity to provide feedback. The Committee supports this proposal. The Committee suggested that this policy take effect once the organs are accepted and an OR time is determined, as opposed to incorporating a time frame. A member noted that including specific timeframes will reduce efficiency in allocation for all organs.