To be included on the national waiting list, a patient must first find a transplant team that will treat him or her. The transplant team, a group of surgeons, nurses and other health professionals at a hospital, evaluates the patient to decide whether he or she is a good candidate for transplantation. In addition to assessing the patient's physical condition, the team will consider the patient's attitude, psychological state and history of drug abuse, among other factors. Donated organs are a rare and precious commodity, so doctors don't want to proceed unless they are confident that a patient is physically and mentally prepared for the procedure, as well as life after the procedure. For the most part, patients who are unwilling to give up unhealthy drugs, including cigarettes and alcohol in many situations, will be automatically disqualified.
If the transplant team feels that a patient is a good candidate for transplant, they will contact the UNOS Organ Center in Richmond, VA, in order to put the patient on the national waiting list. The Organ Center operators record all relevant information about the patient, including his or her physical condition, blood type, tissue type and age. This information is entered into the national database.
When an organ becomes available (when an organ donor is pronounced brain dead at a hospital, typically), the local organ procurement organization (OPO) will gather all relevant information about the donor and enter this data into a program maintained by the UNOS Organ Center. Based on the criteria established by the UNOS board of directors, the program generates a ranked list of potential recipients. The criteria involves several factors, including the physical compatibility between the donor and the recipient, the health of the recipient and how long the recipient has been waiting for an organ. The purpose of the criteria is to choose a recipient who is a good match and stands a good chance of recovery, while also taking into account who has been "in line" longer.
The OPO will immediately contact the transplant team of the first person on the list. The transplant team will note all of the donor's information and make a decision whether or not to accept the organ. It may choose to decline the organ if it feels that the donor and potential recipient are not a close enough match or that the organ is unsatisfactory. For example, the donor may be much larger or older than the potential recipient, making the organ a bad fit, or the donor may have had health problems that could have damaged the organ. The transplant team might also decline the organ if the potential recipient is ill or otherwise unprepared for surgery. If the organ is declined, the OPO will move to the next name on the list.
In most cases, the OPO will first look for potential recipients in the local area. If there are no matches in the local area, the OPO will extend the search to anyone in the UNOS region (there are 11 regions across the country). If there are still no matches, the OPO will offer the organ to the person who is ranked first on the national list. The intention is to minimize organ transportation time and to encourage donation by offering donors a chance to help out their local community.
When a recipient's transplant team accepts the organ, things start moving pretty fast. The team tells the recipient to hurry to the hospital for surgery preparation, and another team is dispatched to remove the organs from the donor. In the next section, we'll see what is involved in both surgical procedures.