UNOS and Transplant Issues Q&A

 

What is an organ transplant?

 

An organ transplant is when a diseased or damaged organ is surgically removed from a patient and replaced by a healthy organ from another person.

 

Which organs can be transplanted?

Liver, kidney, pancreas, heart, lung and intestine are the major organs that can be transplanted.

 

Corneas, bone marrow, vascular structures (blood vessels, heart valves, etc), can also be transplanted, but these transplants are coordinated on a local level and not through UNOS.

 

Doctors have even successfully transplanted skin, face and hands.

 

Are there laws controlling organ transplants?

Yes. Many countries have laws controlling organ donation and transplant. The United States Congress passed a law in 1984 called the National Organ Transplant Act (NOTA). It establishes federal guidelines for organ donation and transplant, but gives authority to individual states to determine laws governing transplant, as long as they fit within the guidelines established by NOTA.

 

NOTA expressly forbids the sale of human organs. This is a point of contention, however, because many people believe a people should be allowed to sell their organs.

 

What is UNOS?

Founded in the mid 1980s, UNOS is the United Network for Organ Sharing. This private, non-profit organization coordinates the transplant system in the United States funded by the federal government. UNOS is the organization that administers the transplant network, Organ Procurement and Transplantation Network (OPTN).

 

What does UNOS do?

UNOS has many responsibilities. One of UNOS’ major efforts is maintaining a national organ transplant waiting list. They also work to ensure quality control, policies regarding new research into transplantation and reporting of transplant results for the general public.

 

What is a regional organ bank?

A regional organ bank may comprise part of a state of several states depending on population. There are 11 regions. The regional organ banks work with hospitals and physicians in the local area to help carry out UNOS policies. Regional organ banks also provide technical support for surgeons when they retrieve organs from cadaveric donors in area hospitals.

 

When a person is declared brain dead in a local hospital, and his/her family indicates a willingness to donate UNOS contacts someone at the regional organ bank. A technician, usually a registered nurse, from the regional organ bank goes to hospital and help manage the patient. These technicians maintain the donor’s blood pressure and respiration until a surgical team can harvest the organs in the operating room. 

Where do organs come from?

Organs can come from two sources—recently-deceased organ donors or live organ donors. Keep in mind that only cadaveric organs are allocated through UNOS. Live donor transplants are coordinated by the institution doing the transplant.

 

What is the UNOS list?

 

The UNOS list is a list of every person in the United States who is waiting for an organ for transplant. The list is really an extensive database, which includes the patient information necessary to determine a match.

 

How are people placed on the list?

When a doctor determines that a patient needs an organ transplant, demographic information and other tests about the patient’s condition must be submitted to UNOS for listing. The criteria for placement on the UNOS list are different for each organ. For example, with liver transplants UNOS requires doctors to submit a MELD score, demographic information, and the patient’s blood type and diagnosis in order to list their patients.

 

How do you know if two people are a match?

Determining if two people are a match for organ transplant depends on which organ is going to be transplanted. In the case of liver transplants, the donor must have the same blood type as the patient. The donor organ size must be approximately the same size as the patient.

 

Organs need to be used quickly after they are harvested from a donor, the donor and recipient need to be a fairly close distance from each other.

 

How are organs given out or allocated?

 

Generally, the recipient with the highest MELD score in the local area or region will receive a compatible organ first. Organs are allocated based on several criteria. Again this depends on the organ being transplanted. The basic process is as follows:

  1. An organ is donated.
  2. Donor’s information is entered into the UNOS database.
  3. The database produces a list of patients who are potential matches. The potential recipients are ranked by how well they match the donor <and ranked by their physical location>. The organ is offered to the first patient on the list.
  4. The hospital where the transplant will take place is notified.
  5. The transplant team at that hospital considers whether or not to accept the organ.
  6. The patient is notified that an organ is available.

 

Does location play a role in who gets an organ?

 

Yes, when an organ becomes available, it is first offered to local patients, then to patients within the region, and then nationally.

 

How long is the wait for an organ?

 

There is no way to know how long a patient will have to wait for an organ. 

 

What is a MELD score?

 

MELD stands for Model for End-stage Liver Disease. It is an objective score that determines the priority for patients waiting for a liver transplant. Scores range from 6 (less ill) to 40 (gravely ill), and are designed to indicate how urgently a patient needs a liver. Specifically, the MELD score predict the patient’s mortality in the next three months.

 

How is the MELD score calculated?

 

The MELD score is based on 3 criteria representative of liver function—bilirubin, creatinine, and prothrombin time (INR).