Organ Allocation

Heather Lindner-Thornton RN, MSN, CPTC

Organ Procurement Coordinator

Background Information…

• Organ allocation in the US is governed by federal law and regulation under the US DHHS

• OPOs have exclusive, defined service areas

• Central to these requirements is the stipulation that that allocation be based on medical criteria, as opposed to social criteria (social worth or wealth).

Impact of Geography

• “Local 1st” philosophy• Local—typically the DSA of the OPO• Regional—midwest • National—U.S.

Objectives of Equitable Organ Allocation

• Maximize the number of organs available for transplantation

• Maximize patient and organ survival, including maximizing the number of life-years gained

• Minimize the number of deaths while waiting for a transplant

• Minimize disparities in the opportunity to receive a transplant among similarly situated transplant candidates

UNet

• A secure internet-based transplant information database

• Created by UNOS for organ transplant centers and OPOs

• Register patients for transplants, match donated organs to transplant patients, and manage the critical data of all patients

• Computer network is accessible 24/7.

UNET Screen Shot

How much information do we need?

Attaching Information

Match Run List

Allocation

• Time accumulated on National Transplant Waiting List

• ABO compatibility• Geography • Size• Age• HLA/PRA• BMI

Actual Match Run

Why doesn’t the 1st patient always get transplanted?

• He/she must be available• Healthy enough to undergo major

surgery• Willing to receive transplant

immediately• Further lab testing required…x-match

Status Code

• Assigned to pts awaiting transplant

• Corresponds with medical urgency (need) for transplant

• One’s you may have heard: 1a and 1b—urgent and may only live 1 week; 2—generally less sick; 7—inactive but can accrue wait time for up to 30 days

0 MisMatch

• Most optimal degree of HLA compatibility

• Appear 1st on match run (local best match)

• Will not appear on DCD match run unless it is a local candidate

Actual Match Run Continued