Pulse
A Network of Networks
How organ distribution works.
By Carmen Peota
In terms of complexity, the logistical challenges of organ allocation rival the medical ones of transplantation. In 1984, Congress passed the National Organ Transplant Act, which called for the establishment of a national registry for organ matching. Since then, donors, recipients, and hospitals have been woven into an intricate national web.
The heart of the system is the United Network for Organ Sharing (UNOS), a private nonprofit organization that holds the federal contract to manage allocation. UNOS maintains the allocation registry, which is essentially a huge database that contains information about potential donors and recipients throughout the United States. UNOS shares information with the nation’s 58 regional organ procurement organizations, which work with the hospitals in their area to procure organs and deliver them to transplant centers. The procurement organization for Minnesota, North Dakota, South Dakota, and three counties in western Wisconsin is LifeSource. Last year, LifeSource helped facilitate 500 organ donations.
National Transplant Leader
In June, Minnesota surgeon John R. Lake, M.D., will become president of the board of directors of the United Network for Organ Sharing, which manages the federal registry and policy-making body known as OPTN (the Organ Procurement Transplantation Network). Lake is director of the liver transplant program and executive medical director for solid-organ transplantation at the University of Minnesota.
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Here’s how the procurement and matching process works: LifeSource receives a call, often from an emergency room or intensive care unit nurse, when a patient has died or when death is imminent. (Federal law mandates that hospitals report all potential donors to the organ procurement organization for their region.) LifeSource staff evaluate the patient’s potential for donation—only 5 percent of people are eligible. If donation is an option, LifeSource sends a staff person to the hospital to talk to the family and gather the medical information necessary to determine a match.
The LifeSource staff person enters that information into the UNOS computer system. UNOS then generates a list of compatible recipients for each organ based on allocation criteria for that organ.
LifeSource notifies the appropriate transplant center that an organ is available. The physicians at the transplant center have the right to accept or refuse the organ based on their assessment of their patient. If they accept it, the LifeSource staff member or a medical provider will deliver it to the transplant center.
UNOS spokesperson Anne Paschke says numerous factors influence what happens in each case. One is the length of time a particular organ can survive outside the human body, or the “cold ischemia time.” She notes that for lungs, the cold ischemia time is only two to four hours and for hearts, it’s four to six hours. Livers last up to 18 hours, and kidneys can last as long as 24 hours. Thus, some organs can only be transported short distances. “For hearts and lungs, after we look in your local area, then we’ll look in a 500-mile radius of the donor hospital. There’s just not time to [offer] those organs nationally like there is with livers and kidneys,” she says.