Issues & Advocacy
Is it really a list? What determines how organs are allocated, and the role UNOS technology plays in it
It’s more complicated than you think
Despite what you may have heard or seen in pop culture, waiting for an organ transplant is not like taking a number and waiting for your turn. People often refer to “the waitlist” to describe how the system works, but the reality of how it all works, and who is involved in the process, is significantly more complicated.
The United Network for Organ Sharing (UNOS), in its role as a federal contractor, helps pair donated organs with patients in need.
UNOS does not decide who gets an organ, nor does it determine which organ is offered to which patient.
Is it really a list?
To better understand how patients are matched with lifesaving organs, it’s helpful to think of the people in need of an organ transplant as being grouped into a “pool” of patients. Patients get added to the “pool” by transplant teams at the patient’s transplant hospital. Those teams evaluate patients and make the final decision on whether or not an organ transplant is the proper treatment. Each time an organ becomes available, UNet – UNOS’ organ matching technology – searches the entire pool for the patients who are a match for the organ based on factors such as blood type, immune system characteristics, organ size and health status. Medical urgency and time spent actively waiting for an organ are also considered. This means every time an organ is available for a transplant, the system creates a new prioritized list, known as a “match run,” from the people in the pool, in the order determined by Organ Procurement and Transplantation Network (OPTN) policy.
Who decides how organs are offered to patients?
When an organ becomes available for transplant and an offer is made to a patient in need, the decision to accept or decline the offer is made by the patients’ transplant team who care for them at their transplant hospital. How organs are allocated is determined by policy, built by independent, volunteer committees made up of donation and transplant professionals, doctors, patient and donor families and members of the public. Those committees are established by the OPTN to write policy and improve the national system. Once a match run is created, organ procurement organizations, or OPOs, use UNet to send offers to patient transplant teams in the order prescribed by OPTN policy. Important decisions about patients, such as accepting an offered organ for a patient, are made by the transplant doctors and teams at transplant hospitals across the country.
What does UNOS do?
As part of its OPTN contract with the federal government, UNOS created and maintains a secure web-based application to collect relevant information about transplant candidates and donors, creates matching algorithms that execute OPTN policies, and connects OPOs with transplant teams. UNOS, under its federal contract, also maintains databases of post-transplant information about patients and living donors to help monitor patients’ health following their transplant. These data can provide feedback to transplant hospitals and OPOs and help the OPTN monitor how policy is working, improve patient safety and write future policy changes.
Let’s take a closer look at how donation and transplant work, and the role UNOS plays in it.
How does this process work?
1. It begins with a generous organ donor. Just about 1% of people who die in the U.S. are eligible to become organ donors, and organ donation only occurs after the patient’s doctor has declared death. Laws across the country vary, but all say in some form that death is declared when a person is determined to have an irreversible and permanent cessation of heart function or brain function. In either case, the declaration of death is made by the doctor caring for the patient. Patients are not declared dead by OPO personnel, transplant teams, nor UNOS. If a patient has all the necessary criteria to become an organ donor, and often after consent is gained from the patient’s family, an OPO team will gather additional medical information about the generous donor and report information such as organ size and condition, blood type and tissue type to UNOS’ DonorNet application. DonorNet is part of the UNet system, which is available online for transplant hospitals and OPOs 24/7.
2. UNOS’ technology generates a match run of potential recipients. After an OPO enters information about the donor and the donor’s organs into DonorNet, the OPO can request a match run to create an ordered list of potential recipients that are actively listed in UNOS’ candidate database, which happens to be named WaitlistSM. Patients appear on the match run in the order dictated by OPTN policies.
3. The transplant hospital is notified of an available organ via UNOS technology. Donation professionals at the OPO use DonorNet to send electronic organ offers for patients in the order of the match run, beginning with the first patient on the list.
4. The transplant team reviews the record in DonorNet to evaluate the suitability of the organ for the patient and chooses to accept or decline the offer. This decision is based on the transplant hospital’s established medical criteria (including compatibility between donor and recipient), organ condition, patient condition, patient availability, and logistics. By OPTN policy, the transplant team has one hour to make its decision before the organ is offered to another patient. If the organ is declined, the OPO continues to offer it to patients in the order they appear on the match run until it is accepted.
5. Once the organ is accepted and the organ recovery surgery is performed on the donor, the OPO coordinates transportation for the organ to the hospital where the transplant is performed.
6. Following the transplant, transplant hospitals monitor the health of transplant recipients and living donors, providing regular updates about the patients’ health status to UNOS’ technology. This is required by OPTN policy to promote patient safety and adherence to OPTN policies.
UNOS is responsible for the work designated in its OPTN contract, which is determined by the Health Resources and Services Administration (HRSA), in accordance with the National Organ Transplant Act, OPTN Final Rule and all OPTN policies. That work, which includes building and maintaining the software that connects a lifesaving organ donation from a generous donor to a potential recipient, is just one piece of the complex network that saves lives through organ donation and transplant every day. UNOS is dedicated to helping people live life without limits by helping people get the lifesaving transplant they need.
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The generous organ donor
The lifesaving system from the perspective of the generous organ donor, their willing family and the organ procurement organization.
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