Frequently asked questions
About UNOS’ role
Myth vs. fact: There are lots of myths about donating organs. Learn the facts about organ donation.
Who can donate and how?
Anyone can become an organ donor, no matter your age. Your medical condition at the time of death will determine what organs and tissue can be donated. If you would like to declare your choice to be an organ donor, be sure to enroll in your state’s donor registry and share your decision with your family and friends. Your decision to donate life can help to save many lives.
What is kidney paired donation?
Kidney paired donation is a living donation transplant option for candidates who have a living donor who is medically able, but cannot donate a kidney to their intended candidate because they are not a match. The OPTN maintains a kidney paired donation pilot program in the hopes that every kidney transplant candidate with an incompatible but willing and approved living donor receives a living donor kidney transplant.
Learn more about the OPTN kidney paired donation pilot program.
How are organs transported?
Organs that are transplanted into a recipient within driving distance commonly travel by ambulance or with specialized carrier companies. Kidneys can be preserved for up to 36 hours before being transplanted. They are commonly transported via commercial airlines and can go all the way across the country if there is a perfect match or a very highly sensitized patient whose body is likely to reject most other kidneys. Hearts and lungs only have 2 to 6 hours and are more likely to travel via chartered or private planes or helicopters.
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What is organ transplantation? Which organs can be transplanted?
If you have a medical condition that may cause one or more of your vital organs to fail, transplant may be a treatment option. A transplant is a surgical operation to give a functioning human organ to someone whose organ has stopped working or is close to failing. In some cases, a living person can donate all or part of a functioning organ. In other instances, the donor would be someone who has recently passed away.
The organs that can be transplanted are:
- Kidney-pancreas (can be transplanted at the same time)
- Heart-lung (can be transplanted at the same time)
- Vascularized composite allografts, or VCAs, such as face, hand or uterus transplantation
When was the first organ transplant?
The first successful transplant was also the first living donor transplant. In 1954 Dr. Joseph Murray transplanted a kidney from Ronald Herrick into his twin brother Richard at what is now Brigham and Women’s Hospital in Boston.
Can I be too old or too sick to receive a transplant?
There is no standard age limit to be transplanted. Each transplant program sets its own practice. For example, one program may not accept anyone older than 80 years of age, while another may have no age limit.
Some medical conditions might rule out a transplant. The transplant team will discuss these with you when you start your evaluation. In general, health issues that may keep you from having surgery or taking long-term medication may be reasons not to list you. Examples can include current or recent cancer diagnosis or morbid obesity. Depending on the medical issues involved, the program may have another specialist examine you and advise whether transplantation would be a safe option.
In some cases, even if a transplant program doesn’t accept you immediately for a transplant, it may reconsider you later if your condition improves (for example, you lose weight as directed, or your cancer goes into remission). You might also consider applying to a different transplant hospital, since each hospital has its own criteria for accepting transplant candidates.
What do I need to do to be considered for a transplant?
A transplant program must evaluate anyone who may wish to have a transplant, and health care professionals there would make the final decision about whether to accept that person as a candidate. You are not automatically listed for a transplant just because you’ve had contact with a transplant program.
Each transplant program makes its own decision about whether to accept someone for a transplant. The transplant team at each program has its own standards for accepting candidates.
Each team may view the same facts and information different ways and make different decisions about listing a person for a transplant. So if one program is not willing to accept you as a candidate, a different program may accept you.
How many organ transplants are successful?
While survival rates differ by organ type, the majority of transplant recipients survive at least one year post-transplant. Kidney recipients tend to have a higher one-year survival rate than heart-lung or intestine recipients. Patient survival rates decrease over time, but the rate of decrease generally slows after the first year.
Graft function plays a role in patient survival. Graft survival is the continued function of the transplanted organ. For some organs, graft failure, or loss of the transplant, would immediately jeopardize the patient’s life without a repeat transplant. For organs such as heart, liver and lung, graft survival is very similar to patient survival. For the loss of other organs, such as the kidney or pancreas, a person may survive a graft failure with other medical treatment. About 95 percent of kidney recipients continue to have graft function at one year, and nearly 80 percent continue to have kidney function at least five years. For pancreas transplants, about 80 percent of recipients have at least one year of function, and 55 to 60 percent continue to have graft function five years or longer.
Waiting and preparing for a transplant
What is the waitlist?
The waitlist is a list of candidates registered to receive organ transplants. When a donor organ becomes available, the matching system dynamically generates a new, specific list of potential recipients based on the criteria defined in that organ’s allocation policy (e.g., organ type, geographic local and regional area, genetic compatibility measures, details about the condition of the organ, the candidate’s disease severity, time spent waiting, etc.).
Learn more facts about the waitlist and what to expect when waiting for a transplant on Transplant Living.
How do I get on the national transplant waitlist?
For most patients who need a transplant, the first step is to get on the national transplant waiting list. Most transplant candidates usually wait for some length of time because there are not enough organs for all who need them. To get on the national waitlist, follow these steps:
- Receive a referral from your physician.
- Contact a transplant hospital. Learn as much as possible about the 200+ transplant hospitals in the United States and choose one based on your needs, including insurance accepted, location, financial options and support group availability.
- Schedule an appointment for evaluation to determine if you are a good candidate for transplant.
- During the evaluation, ask questions to learn as much as possible about that hospital and its transplant team.
The hospital’s transplant team will decide whether you are a good candidate for transplant. Each hospital has their own criteria for accepting candidates for transplant. If the hospital’s transplant team determines that you are a good candidate for transplant, they will add you to the national waiting list. Your transplant hospital will notify you within 10 days to inform you about your date of listing.
How do I know that I am listed?
UNOS does not send patients written confirmation of their placement on the waiting list. Instead, patients should find out if they have been placed on the national waiting list through their transplant hospital. If you have questions about your status on the list, you should ask the team at your transplant hospital.
Where am I on the waitlist?
Many people often think that the national organ transplant waitlist is a static list, like a grocery store checkout line. However, the waitlist is a dynamic, ever-changing pool of information. Where a patient may appear at any point depends on a number of variables about the organs available and about other people in similar need of a transplant. We run these donor and organ characteristics against the list of patients waiting for a transplant who match key factors for that specific organ. Since there is a shortage of organs suitable for donation as compared to the number of those waiting for a transplant, at UNOS we generate a new list for every available organ in order to make the best match for a successful transplant.
You will want to stay in close communication with your transplant hospital on your transplant status.
Learn more facts about the waitlist and what to expect when waiting for a transplant on Transplant Living.
Can I list at more than one hospital?
Yes. This is called “multiple listing.” OPTN policy permits patients to be considered for organs that become available in other areas by being evaluated and listed at more than one hospital. This may reduce your waiting time in some cases, but not always. Each hospital has its own criteria for listing transplant candidates, and each hospital can refuse to evaluate patients seeking to list at multiple hospitals. If you wish to list at more than one hospital, inform your primary hospital and other hospitals you contact.
What questions should I ask the transplant team?
- What kind of medical tests are done in an evaluation?
- What medical conditions might rule me out for a transplant listing?
- Who are the members of the transplant team and what are their jobs?
- How many attending surgeons are available to do my type of transplant?
- Who will tell me about the transplant process?
- Is there a special nursing unit for transplant patients?
- Can I tour the transplant hospital?
- Will I be asked to take part in research studies?
- Does the hospital do living donor transplants?
- Is a living donor transplant a choice in my case? If so, where will the living donor evaluation be done?
- What is the organ recovery cost if I have a living donor?
- What part of the transplant cost is covered by my insurance?
- What financial coverage is accepted by the hospital?
- How much will I have to pay?
- What happens if my financial coverage runs out?
How long will I have to wait?
Once you are added to the national organ transplant waitlist, you may receive an organ that day, or you may wait many years. Factors affecting how long you wait include how well you match with the donor, how sick you are, and how many donors are available in your local area compared to the number of patients waiting.
How will they find the right donor for me?
When a transplant hospital adds you to the waiting list, it is placed in a pool of names. When an organ donor becomes available, all the patients in the pool are compared to that donor. Factors such as medical urgency, time spent on the waiting list, organ size, blood type and genetic makeup are considered. The organ is offered first to the candidate that is the best match.
How can I cover transplant costs?
Transplant policies and organ matching
How do I learn about transplant policies?
Organ Procurement and Transplantation Network policies are rules that govern operation of all transplant hospitals, organ procurement organizations and histocompatibility labs in the U.S. Policies are made through a collaborative process involving committees, the OPTN Board of Directors and the public.
As new policy proposals are developed by the OPTN for consideration, they are circulated for public comment. Learn more about how you can participate in the public comment process.
What factors are considered in organ matching and allocation?
Many medical and logistical characteristics are considered for an organ to be distributed to the best-matched potential organ recipient. While the specific criteria differ for various organs, matching criteria generally include:
- Blood type and size of the organ(s) needed
- Time spent awaiting a transplant
- The relative distance between donor and recipient
For certain organs other factors are vital, including:
- The medical urgency of the recipient
- The degree of immune system match between donor and recipient
- Whether the recipient is a child or an adult
How are organs distributed?
Organs are distributed locally first, and if no match is found they are then offered more broadly, until a recipient is found. Every attempt is made to place donor organs.
How does the matching process work?
The matching process contains five steps:
- An organ is donated. When the organ becomes available, the OPO representative managing the donor reports medical and genetic information, including organ size, and condition, blood type and tissue type to UNOS.
- UNOS generates a list of potential recipients. UNetSM, UNOS’ centralized computer network that links all organ procurement organizations, transplant hospitals and histocompatibility labs, generates a list of potential transplant candidates who have medical and biologic profiles compatible with the donor. The system ranks candidates by this biologic information, as well as clinical characteristics and time spent on the waiting list.
- The transplant hospital is notified of an available organ. Organ placement specialists at the OPO or the UNOS Organ Center contact the programs whose patients appear on the local list.
- The transplant team considers the organ for the patient. When the team is offered an organ, it bases its acceptance or refusal of the organ upon established medical criteria, organ condition, candidate condition, staff and patient availability and organ transportation. By policy, the transplant team has only one hour to make its decision.
- The organ is accepted or declined. If the organ is not accepted, the OPO continues to offer it for patients at other hospitals until it is placed.
- To understand how patients are matched on the national waiting list, it’s helpful to think of the list as a “pool” of patients. Each time an organ becomes available, UNetSM searches the entire “pool” for the patients who are a match for the organ. A new list is made from those who match.
The patients on this new list are ranked in order of their level of match to that donor organ. The organ is offered to the transplant hospital where the first patient is listed. Other factors that may be considered are the patient’s current medical status, geographical location, and time on the list. If the organ is refused for any reason, the transplant hospital of the next patient on the list is contacted. This process continues until a match is made.
Do transplant hospitals in the U.S. only perform transplants on U.S. citizens?
No. Patients from other countries may travel here to receive transplants. Once accepted by a transplant hospital, international patients receive organs based on the same policies as U.S. citizens.