Organ donation: Process

As of May 2015, 123,331 people waiting for life-saving organ transplants in the U.S. Of these, almost 100,000 await kidney transplants. Over 100,000 Americans are on the waiting list in need of an organ, yet on average there are only 30,000 transplants performed each year. Currently, in the United States organ donation is done only with consent of the family or donator themselves.

There are two agencies that govern organ procurement and distribution. The United Network for Organ Sharing and the Organ Procurement and Transplant Network regulate Organ Procurement Organizations with regard to procurement and distribution ethics and standards.Once a donor has been evaluated and consent obtained, provisional allocation of organs commences. UNOS developed a computer program that automatically generates donor specific match lists for suitable recipients based on the criteria that the patient was listed with. Organ Procurement Organizations enter donor information into the program and run the respective lists. Organ offers to potential recipients are made to transplant centers to make them aware of a potential organ.

Various factors are considered: distance from transplant center, blood type, medical urgency, wait time, donor size and tissue typing.

For heart transplantation, medical urgency is denoted by a recipient’s Status (Status 1A, 1B and status 2).

Lungs are allocated based on Lung Allocation Score that is determined based on urgency and wait time.

Livers are allocated using both a status system and MELD/PELD score.

Kidney and pancreas lists are based on location, blood type, Human Leukocyte Antigen (HLA) typing and wait time. When a recipient for a kidney or pancreas has no direct antibodies to the donor HLA the match is said to be a 0 ABDR mismatch or zero antigen mismatch. A zero mismatch organ has a low rate of rejection and allows a recipient to be on lower doses of immunosuppressive drugs.

Location of a transplant center with respect to a donor hospital is given priority due to the effects of Cold Ischemic Time (CIT). Hearts and lungs need to be transplanted within 4–6 hours from recovery, liver about 8–10 hours and pancreas about 15 hours; kidneys are the most resilient to ischemia. Kidneys packaged on ice can be successfully transplanted 24–36 hours after recovery.