Heather Lindner-Thornton RN, MSN, CPTC Organ Procurement Coordinator Organ Allocation Heather Lindner-Thornton RN, MSN, CPTC Organ Procurement Coordinator

Background Information… Organ allocation in the US is governed by federal law and regulation under the US DHHS OPOs have exclusive, defined service areas Central to these requirements is the stipulation that that allocation be based on medical criteria, as opposed to social criteria (social worth or wealth). OPOs have the responsibility for promoting organ donation as well as procuring organs from deceased organ donors. Be based on medical judgment; Seek to achieve the best use of donated organs; Preserve the ability of the transplant program to decline an offer of an organ or not to use the organ for the potential recipient; Be designed to avoid waste & futile transplants and promote patient access to transplantation, and to promote efficient management of organ placement;

Impact of Geography “Local 1st” philosophy Local—typically the DSA of the OPO Regional—midwest National—U.S.

Objectives of Equitable Organ Allocation Maximize the number of organs available for transplantation Maximize patient and organ survival, including maximizing the number of life-years gained Minimize the number of deaths while waiting for a transplant Minimize disparities in the opportunity to receive a transplant among similarly situated transplant candidates Enhance the public’s trust in the fairness and effectiveness of the allocation system

UNet A secure internet-based transplant information database Created by UNOS for organ transplant centers and OPOs Register patients for transplants, match donated organs to transplant patients, and manage the critical data of all patients Computer network is accessible 24/7.

UNET Screen Shot

How much information do we need?

Attaching Information

Match Run List After info entered we run match run. OPO has no “say” as to who comes up first on list. We have to allocate off the match run and in order.

Allocation Time accumulated on National Transplant Waiting List ABO compatibility Geography Size Age HLA/PRA BMI (to ensure donor organ quality and reduce ischemic time, organs are allocated first to patients within local areas before being distributed to increasingly larger allocation lung: Generated by an algorithm that considers predictions of waiting list survival and post-transplant survival.

Actual Match Run

Why doesn’t the 1st patient always get transplanted? He/she must be available Healthy enough to undergo major surgery Willing to receive transplant immediately Further lab testing required…x-match

Status Code Assigned to pts awaiting transplant Corresponds with medical urgency (need) for transplant One’s you may have heard: 1a and 1b—urgent and may only live 1 week; 2—generally less sick; 7—inactive but can accrue wait time for up to 30 days

0 MisMatch Most optimal degree of HLA compatibility Appear 1st on match run (local  best match) Will not appear on DCD match run unless it is a local candidate

Actual Match Run Continued