Wait-Listed: The Organ Procurement Process
Waiting for a suitable donor organ to become available may take one week to many months. Unfortunately, the latter is more often the case. This waiting time has been described by many transplant recipients and their families as the most difficult part of the transplant process. Fear and anxiety are normal reactions during this period of uncertainty.
Because this can be a frustrating and difficult time, we urge candidates and their families to join and regularly attend support group sessions. Your social worker and transplant coordinator will provide information on these opportunities. The Support Services section of this website also provides information on local and national resources.
What is Involved in Finding Your New Heart?
Once you are accepted into the transplant program at NYPH/Columbia, you are registered on the national UNOS (United Network for Organ Sharing) waiting list. Established by Congressional Act in 1984 as a nationwide umbrella organization for transplantation, UNOS's mission is to promote and advance the science of transplantation, and to increase the availability of donor organs. UNOS manages the national transplant waiting list, matching donor organs to recipients 24 hours a day, 365 day a year. It monitors every organ allocation to ensure compliance with equitable policies that maximize the limited supply of organs and give all patients a fair chance at receiving the organ they need, regardless of gender, race, religion, lifestyle, and financial or social status.
Hospitals are now required to have organ recruitment policies and procedures to identify potential donors, tell their families about organ donation opportunities, and to notify a local organ procurement organization (OPO) about potential organ availabilities. In January 1998, New York State passed the Required Request Law which mandates that families of potential donors be informed about their option to donate.
Once a donor is identified by the hospital and the OPO is contacted, the Organ Procurement Organization will determine the organ's suitability for donation and, if suitable, coordinate its distribution. However, if the potential donor's family decides not to allow the organ to be used, it is not removed.
A suitable heart donor is a young to middle-aged person who has been declared "brain dead" based on standard criteria, and whose heart is still functioning. All donors are screened to make sure the Hepatitis B and C and HIV viruses are not present. Any evidence of these infections precludes use of the organ for transplantation.
Donor hearts are provided to patients based on the donor's blood type and body weight, the recipient's severity of illness, and geographic location. These data are contained in the UNOS computer database.
UNOS maintains the national patient waiting list, but all transplant hospitals and OPO personnel can access the information. Although you may hear of a local, regional or national list, they are all just parts of the same list. For example, a local list would include candidates from several hospitals within a geographic area that is covered by one organ procurement organization.
When a donor organ becomes available and is typed, that portion of the waiting list local to its hospital location is checked first. Patients are listed in order according to the national policy which favors severity of illness and time on the list. If no suitably-typed recipients are waiting on the local list, the search is expanded to the region. The regional list can include several counties, a state or several states. Again, potential recipients are listed according to the national organ distribution criteria. If no matching patients are found on the regional list, the national list is then checked. So, the rules by which patients are offered organs remain the same, only the number of patients grows with each expansion of the list.
When a transplant team at the matched recipient's hospital is notified of a suitable heart, they travel quickly to the donor hospital. There, they remove the heart and place it in a special cold preservation solution. A heart can be outside the body for only about four hours before it loses the ability to function once transplanted. Thus, timing is crucial. When the heart is removed, the recovery team returns to their hospital where the transplant operation will be performed.