Organ matching
Through the UNOS Organ Center, organ
donors are matched to waiting recipients 24 hours a day, 365
days a year. Through its policies, UNOS ensures that all patients
have a fair chance of receiving the organ they need regardless
of age, sex, race, lifestyle, religion and financial or social
status.
UNOS members include every transplant program,
organ procurement organization and tissue typing laboratory in
the United States. Policies governing the transplant community
are developed by the UNOS membership through a series of regional
meetings, deliberations at the National Committee level and final
approval by a 40-member board of directors, comprised of medical
professionals, transplant recipients and donor family members.
After the family graciously consents to organ
and tissue donation, an extensive medical evaluation takes place.
This evaluation determines which organs and tissues are suitable
for transplantation and ensures the medical transplant community
and recipients that these organs are healthy and without communicable
disease.
Initially information about the organ recipient
is entered into the UNOS computer. Information such as date and
time listed, name, height, weight, blood type, social security
number, transplant center telephone number for referrals, number
of transplants the patient has received and status are entered.
A patient's status is his or her medical status, which is assigned
according to the state of end-stage organ failure which determines
urgency of the need for transplant for each individual patient.
Organ allocation
Once the recipient is listed, the patient waits until donor information
is entered into the same UNOS computer system which prompts a match run
of recipient to donor information. A list of potential recipients is
generated by the UNOS computer, in order of priority. The greatest need
in a local area would go to the sickest patient, who was compatible with
the donor size (height, weight) and blood type, which had waited on the
list the longest period of time. In the case of liver and small bowel
allocation, if no suitable match is found within the state boundaries,
the match list is extended to regional sharing. Nebraska shares a six-state
region with Iowa, Kansas, Missouri, Wyoming and Colorado. If no match
is found at the regional level, the match list is extended to a national
level until a suitable match can be found. The organ allocation system
is slightly different for heart, lung, kidney and pancreas.
The transplant center surgeon and physicians
receive information regarding a potential donor referral from the
organ recovery coordinator. It is determined whether or not to
use the referred organ for transplant based on medical suitability
for their recipient.
The transfer
of organs
Once the organ is accepted, a procurement team
is assembled. The team includes a transplant surgeon,
surgical assistant and an organ recovery/perfusion
coordinator. Surgical equipment, perfusion and packaging
supplies are taken to the donor hospital by expeditious
means of transportation to meet the coordinated surgical
operating room times agreed upon by multiple transplant
teams. The transport times must be kept to a minimum
to assure that minimal cold ischemic times are accrued
on each organ. Ischemic times are from the point the
organ is surgically removed from the donor to the time
the organ is transplanted and re-perfused with the
blood and oxygen of a recipient. The length of ischemic
times can effect the overall function of the organ
post-operatively, so close attention is paid to keeping
this time as short as possible.
This organ recovery system allows transplant
centers and OPO's to send trained organ recovery professionals
to the most remote and rural hospitals to facilitate the organ
and tissue donation process with the cooperation of their own hospital
staff.
The organs are removed by the transplant surgeons
at the donor hospital. A surgical procedure which isolates each
individual organ’s anatomy and the essential vessels which
are necessary to transplant the organ successfully into the recipient
is used to remove the organs. Prior to removing the organs, a clamp
is placed on the aorta to stop blood flow to the organs. An ice
cold solution at four degrees centigrade is used to flush blood
out of the organs to begin the preservation process.
The organs are then packed into three sterile
bags or sterile containers, packed in wet ice, placed in a cooler
and transported back to the transplant hospital. The Organ Recovery
Coordinator is in close contact during the procurement procedure
with the transplant hospital to inform them of their estimated
time of return with the organ. The transplant center contacts the
organ recipient as soon as they are notified that the organ is
suitable for transplant. Most transplant centers require a recipient
to be at the transplant center within 4 to 6 hours of notification
that a suitable donor has been found for them. In the case of a
heart or lung transplant, this time may be shortened and in the
case of a kidney or pancreas it may be extended.
Admission
to hospital
At the transplant center, the recipient is admitted
to the hospital, lab tests are drawn along with vital signs and
further education about the transplant process is presented to
the recipient and finally a surgical consent form is signed. Organs
are never removed from the recipient until the procurement team
returns to the hospital with the organ.
The transplant takes place as soon as
the transplant surgeon reexamines the donor organ. The organs
are examined in the operating room to ensure that the anatomy
is normal, there is no trauma and the organs are suitable for
transplant into a waiting recipient. The patient is put to sleep
via anesthesia, an incision is made and the diseased organ is
removed and replaced with the healthy new organ. The patient
is then sent to the intensive care unit for the postoperative
phase. Most uncomplicated transplant recipients are extubated
(breathing tubes removed) within 24 hours after transplant with
a plan already in motion for the physical rehabilitation of the
patient. The pace is quick throughout the recovery process to
prevent any undue post-operative complications that immobility
may cause and to keep health care costs to a minimum.
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