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Matching and Allocation of Organs

The Matching Process

When a deceased organ donor is identified, a transplant coordinator from an organ procurement organization accesses the UNet system. Each transplant candidate in the "pool" is matched by the system against the donor characteristics. The system then generates a ranked list of patients, called a "match run," for each organ that is procured from that donor in ranked order according to organ allocation policies. Factors affecting ranking may include tissue match, blood type, length of time on the waiting list, immune status and the distance between the potential recipient and the donor. For heart, liver and intestines, the potential recipient's degree of medical urgency is also considered. Therefore, the UNet system generates a differently ranked list of patients for each donor organ matched.

The organ is offered to the transplant team of the first person on the list. Often, the top transplant candidate will not get the organ for one of several reasons. When a patient is selected, he or she must be available, healthy enough to undergo major surgery and willing to be transplanted immediately. Also, a laboratory test to measure compatibility between the donor and potential recipient may be necessary. If the organ is refused for any reason, the transplant hospital of the next patient on the list is contacted. The process continues until a match is made. Once a patient is selected and contacted and all testing is complete, surgery is scheduled and the transplant takes place.

The Five Steps:

  1. An organ is donated. When the organ becomes available, the OPO managing the donor sends information to UNOS. The OPO procurement team reports medical and genetic information, including organ size, and condition, blood type and tissue type.

  2. UNOS generates a list of potential recipients. The UNOS computer generates a list of potential transplant candidates who have medical and biologic profiles compatible with the donor. The computer ranks candidates by this biologic information, as well as clinical characteristics and time spent on the waiting list.

  3. The transplant center is notified of an available organ. Organ placement specialists at the OPO or the UNOS Organ Center contact the centers whose patients appear on the local list.

  4. 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.

  5. The organ is accepted or declined. If the organ is not accepted, the OPO continues to offer it for patients at other centers until it is placed.

The Allocation Process

Who and What is Involved in the Organ Allocation Process?

  • The UNOS Organ Center: Staffed with organ placement specialists, the UNOS Organ Center coordinates the efforts of many transplant professionals at the OPO and transplant center with the needs of the patient. It is located in Richmond, Virginia.

  • The OPO: An  Organ Procurement Organization is responsible for evaluating potential donors, discussing donation with family members, arranging for the removal and transport of donated organs, and educating the public about the need for donors.  The OPO staff  (transplant coordinators) coordinate activities relating to organ donation in states and regional areas throughout the U.S.

  • The Organ Donor: This person has died, is compatible with the recipient and meets certain criteria.

  • The Transplant Candidate: This person needs a new organ because he or she has suffered from end-stage organ disease. A transplant center has also evaluated this patient, determined that he or she is a candidate for an organ transplant and has added him or her to the national waiting list.

  • The Transplant Recipient: A person who has received an organ transplant.

  • The Procurement Team: This is a group of professionals who work at an organ procurement organization (OPO) or transplant center and coordinate the recovery of the organ. They remove the organs from the donor's body, so that they can be transplanted.

  • The Transplant Team: These are healthcare personnel who perform the transplant operation. They also take care of the patient before, during and after the transplant operation.

  • UNetSM: The secure Internet-based transplant information database created by UNOS for the nation's organ transplant centers and OPOs to register patients for transplants, match donated organs to transplant candidates, and manage the critical data of all patients. This computer network is accessible 24 hours a day, seven days a week

For information on Financing a Transplant 

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Kidney & Urology Foundation of America
104 West 40th Street, Suite 500 | New York NY 10018 | 212.629.9770
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Website Last Modified: January 23, 2022
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