Transplant Step-by-Step

The National Waiting List

UNOS policies govern how organs will be matched with recipients and how the waiting list will be maintained.

Physicians treating patients decide if a transplant is needed and add the patient to the UNOS database. It is the physician treating the patient that decides the priority the person should be given on the national waiting list, according to a UNOS spokesperson.

For example, a patient needing a kidney transplant may not be high on the waiting list if they can be kept alive with dialysis treatments. However, if the patient gets worse, the physician may "bump" them up the list after assessing their condition, according to a UNOS spokesperson. UNOS criteria for bumping up are strict and all list changes must be requested and approved by UNOS, according to CTDN.

Who receives a donated organ depends on the organ, the match and proximity. Thus a donor in a Northern California hospital would most likely be matched up with a recipient in Northern California.

UNOS regulations and policies are lengthy and detailed and are available on the organization's website.

Transplant Step-by-Step

The process of connecting a donated organ with a transplant patient is an intricate and delicate one-a spider's web that link together patients, hospitals, organ and tissue procurement organizations, and a national transplant waiting list, all governed by a maze of federal regulations.

It begins when a patient at a hospital has died or is about to die. Federal law mandates hospital staff to notify an organ procurement organization (OPO) about all deaths and all imminent deaths.

During the 1980s, Congress responded to gains being made in transplant science and passed the National Organ Transplant Act, providing money for qualified organ procurement organizations to expand operations.

In California, for example, there are four federally designated organ procurement organizations: OneLegacy in Los Angeles, Life Sharing Community Organ Donation in San Diego, Golden State Donor Services in Sacramento and Oakland-based California Transplant Donor Network.

CTDN works with 160 hospitals in 40 counties in Northern and Central California and Northern Nevada. CTDN's job is to field calls from hospitals, approach families about donation, coordinate organ and tissue recovery and placement and provide public education.

Besides the organ procurement organizations, hospitals also are required by federal law to have a contract with a tissue and eye bank to notify them of potential donors.

Every person is considered a potential donor, whether they carry a Department of Motor Vehicle donor card or not, because family consent must be given before any organs or tissues can be recovered.

Hospitals don't have a choice of what OPO to work with, but they do have options about which tissue and eye bank they use. OPOs are federally designated; tissue and eye banks are not.

On the opposite end of the process is the United Network for Organ Sharing (UNOS), a non-profit, scientific and educational organization that maintains waiting lists for organ donations, working closely with the Health Resources and Services Administration and the U.S. Department of Health and Human Services. UNOS has many responsibilities. It administers the Organ Procurement Transplantation Network, which collects data on transplants and facilitates organ matching and placement.