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).

Impact of Geography “Local 1 st ” 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

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

Allocation Time accumulated on National Transplant Waiting List ABO compatibility Geography Size Age HLA/PRA BMI

Actual Match Run

Why doesn’t the 1 st 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 1 st on match run (local  best match) Will not appear on DCD match run unless it is a local candidate

Actual Match Run Continued