Behind the Complex Balancing Act to Save Lives Every Day

To say that the organ donation and transplantation process is complex would be an understatement.

The United States has an effective, inclusive and diverse transplant system that saves thousands of lives every year. It has taken decades to get us to this point, made possible due to the gifts of generous donors and their courageous families and the meticulous coordination that takes place every day between patients, physicians, hospitals, organ procurement professionals and volunteers.

As the Chief Medical Officer at United Network for Organ Sharing (UNOS) and the former medical director of major university-based kidney and transplant programs, I have the unique experience of knowing what this lifesaving system looks like up close.

What is UNOS?

UNOS powers the nation’s organ donation and transplant system. We hold the federal contract to serve as the Organ Procurement and Transplantation Network (OPTN), established by Congress in 1986, which also requires that a private, nonprofit organization oversee the transplant system, with decision-making authority given to patients and medical professionals.

UNOS built, maintains and upgrades the nation’s computerized national waitlists of organ transplant candidates. We also built the secure technological infrastructure that makes it possible to offer donor organs to patients in need. In collaboration with transplant professionals and many other stakeholders, we establish policies that allocate organs to waitlisted patients. Patients, physicians, surgeons and others discuss and develop policies in an effort to allocate donor organs equitably and efficiently. Finally, we work with transplant centers and organ procurement organizations to drive improvements and bolster performance.

This extensive national infrastructure and the people who power it are committed on a single purpose: to ensure that patients can receive the gift of life from a generous organ donor.

The Generous Donor

Organ donors are most commonly patients in hospitals who, due to severe injury or illness, have been declared brain dead but whose organs may remain viable for transplant. It’s important to remember that less than 1% of people die in a way that makes organ donation possible.

Physicians exhaust every available option to save a patient’s life. However, if the patient passes away, other lives may be saved through organ donation. At that point, the hospital contacts their local Organ Procurement Organization (OPO), one of 56 regional nonprofits that assess, collect and transport donated organs. OPO staff are trained to counsel families during one of the most difficult moments of their lives.

If the deceased patient is a registered organ donor, the OPO works with the family so they understand the donation process. If the patient was not registered as an organ donor, the OPO staff will offer the family the option to donate.

We should not underestimate the importance of this decision and the strength and courage required by a family during such an emotional time. This decision is transformational – a single donor can save up to eight lives.

Making the Match

After the OPO confirms donation consent, their staff determine if a deceased donor’s organs are viable for transplant. If so, they enter the patient’s medical information into the UNOS database. It generates a list of best match candidates based on a variety of clinical factors, including blood type, body size, severity of illness, distance from the donor hospital and time on the waitlist. 

Currently, more than 100,000 patients are on the national waiting lists, the majority of whom are waiting for a kidney transplant. Potential transplant recipients are placed on the transplant waiting lists after being referred and evaluated at a transplant hospital.

While popular culture has trained us to think otherwise, no patient has a fixed position on the national waitlist; in fact, a patient’s place on it can change over time. It’s more accurate to think of the waitlist as a pool of candidates, awaiting the organ that best fits their unique genetic and medical profile.

Once the UNOS system has produced a list of candidates who best match the available donor organs, the OPO contacts the transplant hospitals of matched patients, once again using UNOS’ computer systems.

A Race against Time

After an organ has been accepted by the patient and their doctors, time is of the essence; organs can be preserved outside the body for only a short time – often just a few hours. The organs are then respectfully recovered from the generous donor.

The OPO arranges to transport the donated organ to the transplant hospital. Once the medical team transplants the organ, a life can be saved, quality of life can be improved and a donor’s legacy can be honored. Recovery from a transplant differs from patient to patient, but each include life-long medications and lifestyle changes.

This complex, lifesaving process, with its many moving parts and medical, logistical and geographic requirements, happens every day. It is successfully replicated across the country seven days a week, 24 hours a day, 365 days a year.

A Lifesaving Goal

We are proud of the results. We have now surpassed over 1 million transplants in the United States since the nation’s first successful transplant in 1954. In 2022 alone, over 42,800 transplants were performed – more than any other year. Our transplant system continues to set lifesaving records thanks to generous donors, their courageous families and the hard work and dedication of those who make up this diverse and thriving national system.

Understanding how the system works, the people who make it possible, the lives saved and the donors honored is essential to advancing our shared goal of driving continuous system improvement to save as many lives as possible.