The Matching Process — Waiting List
Waiting List
Here are the necessary steps to get on the national waiting
list:
- Obtain a referral from a physician.
- Contact
a transplant hospital
.
Learn as much as possible about the 200 plus transplant
hospitals in the United States and choose one based on individual
needs, including insurance, location, finances, and support
group availability.
- Schedule an appointment for evaluation at the transplant
hospital to determine if you are an appropriate candidate
for a transplant.
- During the evaluation, ask
questions
to learn as much as possible about the hospital and its
transplant team.
- Once the evaluation is completed, the hospital's
transplant team
will determine when it is appropriate to be added to the
national waiting list.
The United Network for Organ Sharing (UNOS) maintains a centralized
computer network, UNet sm , that links all organ procurement
organizations (OPOs) and transplant centers. The national
waiting list is maintained on UNet sm . This list is open
only to transplant professionals who are members of the Organ
Procurement and Transplantation Network. It cannot be accessed
by the public.
Patients are not notified by UNOS when they
are added to the waiting list. The transplant team that did
the evaluation contacts the patient in writing within 10 days
and notifies the patient of the date and time their name was
added to the list. The patient then directs questions about
their status on the waiting list to the transplant center’s
transplant team.
Who Gets a Heart?
The average national waiting time for a heart is
230 days. (UNOS/OPTN Annual Report 2003) People waiting for
a heart transplant are assigned a status code, which indicates
how urgently they need a heart. Because thoracic organs such
as the heart and lungs can only survive outside the body for
4 to 6 hours (Partnering
With Your Transplant Team (PDF) ,
page 10), they are given first to people who live near the
place where the donor is hospitalized. If no one near the
donor is a match for the heart, the transplant team starts
searching farther away through a series of zones in a specific
sequence. See the OPTN/UNOS Allocation
of Thoracic Organs Policy (PDF)
for details.
Who Gets a Lung?
The average waiting time for a lung is 1,068 days.
(UNOS/OPTN Annual Report 2003) The UNOS team divides people
waiting for lung transplants into two groups – people
who need only one new lung and those who need two. The lung
allocation system uses clinical information—including
lab values, test results, and disease diagnosis—to estimate
the urgency of a candidate’s need for transplant and
the likelihood of prolonged survival following the transplant.
This lung allocation score, as well as blood group, age, and
distance from the donor hospital are considered to determine
the order in which a donated lung is offered to candidate
recipients. Distance is important because lungs can only survive
outside the body for 4 to 6 hours (Partnering
With Your Transplant Team (PDF) ,
page 10); they are offered first to people near the donor.
If no one near the donor is a match for the lung, the transplant
team starts searching farther away through a series of zones
in a specific sequence. A pair of lungs will either be given
to one person who needs them both, or divided between two
people who need single lung transplants. See the OPTN/UNOS
Allocation
of Thoracic Organs Policy (PDF)
for details.
Who Gets a Heart and a Lung?
Candidates for a heart-lung transplant are registered
on both the UNOS Heart Patient Waiting List and the UNOS Lung
Patient Waiting List. If a donor heart is available, the patient
will receive a lung to go with it from the same donor. If
the patient is eligible to receive a lung, the donor’s
heart will be given to the heart/lung patient as well. Because
thoracic organs can only survive outside the body for 4 to
6 hours ( Partnering
With Your Transplant Team (PDF) ,
page 10), they are given first to people near the donor. If
no one near the donor is a match for the heart and lungs,
the procurement team starts searching farther away through
a series of zones in a specific sequence. See the OPTN/UNOS
Allocation
of Thoracic Organs Policy (PDF)
for details.
Who Gets a Liver?
The average waiting time for a liver is 796 days.
(UNOS/OPTN Annual Report 2003) Candidates who need a liver
transplant are given a MELD/PELD score (Model for End-Stage
Liver Disease/Pediatric End-Stage Liver Disease) that indicates
how urgently they need the organ. A liver will be offered
to the candidate with a matching tissue type and the highest
MELD/PELD score first (the high score indicates the greatest
need.) If the first donor’s surgeon does not accept
the organ then the liver specialists at UNOS will offer the
liver to matched patients according to the MELD/PELD scores
until the organ is accepted. Geographic factors are also taken
into consideration, but livers can stay healthy outside the
body for 12 to 24 hours so the UNOS liver team has greater
flexibility than the teams that work with hearts and lungs
( Partnering
With Your Transplant Team (PDF) ,
page 10). See the OPTN/UNOS Allocation
of Livers Policy (PDF)
for details. To learn more about how MELD/PELD scores are
assigned, see the OPTN
MELD/PELD calculators 
Who Gets a Kidney?
The average waiting time for a kidney is 1,121 days.
(UNOS/OPTN Annual Report 2003) When a UNOS team selects possible
recipients for a donor kidney, they consider a variety of
characteristics of both the donor and the recipient, including
tissue match, blood type, blood antibody levels (which show
how active the immune system is at the current time –
too much activity increases the risk of rejection), length
of time on the waiting list, whether the recipient is a child,
whether the body sizes of the donor and recipient are a good
match, and geographic factors. Kidneys can stay healthy outside
the body for between 48 and 72 hours, so the UNOS kidney team
can consider many more candidates than the heart or lung teams
Who Gets a Pancreas?
The average waiting time for a pancreas is 501 days.
(UNOS/OPTN Annual Report 2003) The pancreas can remain healthy
outside the body for 12 to 24 hours .A person who is offered
a donor pancreas can be selected from people waiting for a
pancreas transplant alone, a kidney-pancreas combination transplant,
or a combined kidney-pancreas-islet transplant. The Islets
of Langerhans are cells inside the pancreas that secrete insulin.
They can be transplanted by themselves if the whole organ
does not need to be used. An islet transplant is the kind
of transplant that is most useful for people with diabetes
whose pancreas is healthy but the Islets of Langerhans, do
not make insulin. Insulin is needed to break down sugar. People
who have had pancreatitis (inflammation of the pancreas) and
have damage all through their pancreas need the whole organ.
See the OPTN/UNOS Allocation
of Pancreas Policy (PDF)
for details.
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