How do transplant UNOS and the wait list work?
The Cleveland Clinic Heart Center and other such facilities procure organs for transplant from the Richmond, VA-based United Network for Organ Sharing (UNOS). This national organ procurement and allocation network collects and maintains transplant statistics nationwide. Its members include every transplant program, procurement organization, and tissue-typing laboratory in the United States. UNOS policies ensure equitable allocation based on scientific and medical criteria to patients registered on the national waiting list. Favoritism based on race, gender, political affiliation, or financial status is not tolerated.
The way it works is this: The names of patients requiring transplants are placed in a pool in the UNOS computer. Names are not ranked at that point; each donor organ generates a differently ranked list. When a donor organ becomes available, each name in the pool is matched by the computer against the donor characteristics. The computer then generates a list of patients ranked according to UNOS policies on allocation, and the organs are offered to physicians with patients waiting for transplants.
"An important priority for donor hearts is to find potential recipients within the locality of the donor hospital," say Robert W. Stewart, MD, a cardiac surgeon and head of cardiac transplantation at The Cleveland Clinic Heart Center. "The longer an organ needs to be transported, the less favorable an outcome can be expected."
The search is then broadened to a larger region — nationwide if necessary. For heart, liver, and intestinal organs, the potential recipient’s degree of medical urgency is considered: Is the patient in critical condition? Is he or she status one? The patient selected must be willing, immediately available, and healthy enough to undergo major surgery.
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