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Automate real-time donor referral

Establish better metrics

Get the right organ to the right patient

Remove disincentives

Enable OPOs to merge or share services

Save even more lives

The U.S. has the highest performing donation and transplant system in the world. But as good as it is, it needs to get even better to support the more than 100,000 patients on the waiting list. Based on the input of experts in our field, UNOS is proposing a five-part package of reforms to drive improvements to save even more lives.


Identifying potential organ donors is a vital step to maximizing the efficiency of the U.S. organ donation and transplant system and ensuring as many organs as possible get to those who need them. Deceased donor organs can only come from people who have passed away in a hospital while on a ventilator or shortly after withdrawal of mechanical support. The timing of referrals to OPOs is critical to ensure viability of organs from a potential donor for transplantation. Donor hospitals routinely report imminent deaths to OPOs for people who meet broad criteria for deceased donation, but the timelines vary from hospital to hospital and the demands of patient care can cause unintended delays.

Also, the screening process to determine donor potential and gain authorization for actual donors is resource-intensive for donor hospitals and OPOs. Donors must be carefully screened to minimize risk of donor-transmitted illness and each organ must be screened to ensure the likelihood of long-term function if transplanted. OPOs, often reflecting the preferences of transplant programs they serve, have different methods and standards for identifying potential donors. In turn this leads to inconsistencies in the identification process and subjective differences in calculating the number of potential deceased donors. Without a streamlined and clinically relevant process in place to identify potential organ donors, and a national standard for referral data elements, some lives that could be saved may not be.


Automated donor referrals remove much of the variation in timeliness and the subjective element of identifying potential organ donors. They also lift the burden of reporting that falls on donor hospital staff, allowing them to concentrate more on patient care, instead of administrative requirements. Such automated processes use hospital electronic medical records systems to flag potential candidates for donation and send an automatic message to the collaborating OPO, which dispatches a team to assess and recover the organ. Multiple OPOs have successfully piloted the use of automated donor referral systems.

Some observers say universal application of automating donor referrals would be too costly, but UNOS believes costs are minimal because the technical requirements are relatively simple and can be duplicated across the major hospital electronic health record systems.  After nearly $30 billion in federal subsidies has been dedicated to electronic medical record development, it would seem wise to leverage that investment and technology through the regulatory system into as many opportunities as possible. We also believe the number of additional lives saved and long-term medical expenses eliminated by organ donation would be worth the cost.


UNOS will continue leading collaborative work underway now with OPOs and transplant hospitals to establish a national standard for donor referral data. The Centers for Medicare and Medicaid Services should then require all donor hospitals to establish automatic electronic donor referral systems to comply with the existing regulatory requirement to refer all inpatient deaths to the OPO in a timely fashion—or provide strong incentives to do so.

Originally published on Sept. 15, 2020; updated Dec. 5, 2020

1 million transplants

The U.S. surpassed 1 million transplants in 2022

The gifts of generous donors and their courageous families made several lifesaving transplant records possible.


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Benefits of automated donor referral

  • Accelerates the timeline of organ screening, procurement, and transplantation.
  • Increases the validity of potential donor data and boosts our ability to analyze OPO performance and improve it.
  • Shifts the burden of identifying and reporting potential organ donors away from hospital staff, allowing them to concentrate more on patient care.
  • Maximizes the efficiency of the entire system and ensures as many organs as possible get to patients who need them most.

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