More than 100,000 people are waiting for a life-saving organ in the United States, with a new name added to the list every nine minutes.
So, how does the U.S. organ transplant system work? To find out, we spoke with Anne Paschke, a spokeswoman for the nonprofit that runs the country’s organ transplant system.
Here’s what we learned:
Who oversees the U.S. organ transplant system?
The country’s organ transplant system — the Organ Procurement and Transplantation Network — is managed by the United Network for Organ Sharing, or UNOS, the Richmond-based nonprofit that has a contract with the federal government to operate the national organ wait-list system. (The nonprofit has a $6.5 million annual contract with the U.S. government, according to the Washington Post.)
“We match organs to patients, not to transplant centers,” said Paschke.
How many transplant centers are there in the U.S? How many are in Florida?
There are more than 250 active transplant centers in the United States and 12 of them are in Florida. Keep in mind that not every transplant center has a program for every organ.
Here are the transplant centers in South Florida:
▪ Miami Transplant Institute, located in Jackson Memorial Hospital and staffed by University of Miami medical school physicians. The institute has transplant programs for a variety of organs, including kidneys, lungs, pancreas, intestines and livers. It also does heart transplants, but its adult heart transplant program is currently suspended and undergoing an overhaul amid multiple investigations involving patient deaths and infection rates. The institute is still performing pediatric heart transplants.
▪ Memorial Transplant Institute, at Memorial Regional Hospital and Joe DiMaggio Children’s Hospital in Hollywood, offers adult and pediatric transplants for hearts and kidneys. It also recently opened a pancreas transplant program.
▪ Cleveland Clinic Weston offers heart, kidney and liver transplants.
How can people become organ donors?
Generally speaking, in order to donate organs — heart, lungs, kidney, liver, pancreas and intestines — the patient would have to die in the hospital and be on a ventilator so the organs can continue to receive oxygen.
This accounts for less than 2% of the eligible population, said Paschke. Someone who dies at home may still donate their eyes and tissue.
You don’t have to wait until death to donate certain organs. Healthy adults can become living donors for kidneys, livers and in rare cases, uterus or segments of other organs, according to the organ transplant network. You have two kidneys and can generally live with one; you can donate a section of a healthy liver as it regrows within weeks.
If you want to become an organ donor, enroll in your state’s donor registry. Family members can donate a loved one’s organs, even if they never registered to do so. But this can be a difficult end-of-life decision to make, so it’s best to make those decisions ahead of time.
It’s also worth noting that while family can choose to donate organs of a loved one, they can’t override your decision to donate organs if you have registered to do so.
How do patients find an organ match?
Medical information from donors and patients are input into the nationwide organ transplantation system.
When an organ becomes available, the electronic system will rule out everyone on the wait list who is incompatible, and rank the remaining patients based on the system’s allocation policies. Then, offers are sent out to the transplant centers that have patients at the top of the list, according to Paschke.
It’s then up to the patient’s transplant surgeon to accept or reject the organ offer. They have an hour to make a decision before the system sends out the organ offer to another patient, she said.
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Doctors look at a variety of factors to determine if an organ is a match, including age, lab test results and pictures of the donor’s organ(s). Some of this information, such as blood type, is from testing done through histocompatibility laboratories. These labs analyze the blood of donors and recipients so that doctors can assess whether a patient’s body will likely reject or accept an organ.
There are five labs in Florida: One is at Jackson Memorial Hospital/the University of Miami Miller School of Medicine in South Florida. The other labs are in the Mayo Clinic in Jacksonville; Shands Hospital in Gainesville; AdventHealth Orlando; and LifeLink Florida in Tampa.
Does age play a role in transplant eligibility?
Paschke said the country’s organ transplant network doesn’t restrict organ transplants based on age and lets hospitals and their doctors decide which patients are good candidates for a transplant. Some hospitals accept sicker, older patients while some may not.
For example, Cleveland Clinic Weston, a privately owned hospital, and Memorial Regional Hospital in Hollywood, one of Broward’s public hospitals, accept patients age 70 and older on a case-by-case basis for heart transplants. Jackson also accepts patients age 70 and older.
Some patients may seek to join the wait list at multiple transplant centers, but a transplant center’s physician decides who will be on a wait list.
How does a patient move up on the wait list?
A person’s position on the wait list depends on how urgently they need a new organ, and can go up or down depending on changes in their health or treatment. Generally speaking, the sicker you are, the closer you get to the top of the list for a new organ.
While blood type, height, weight and other medical factors are automatically screened, every organ type also has its own individual distribution policy.
For a person who needs a new heart, for example, certain factors — distance from the donor’s hospital and whether a patient has a heart pump or other support device —helps determine their urgency status, according to the heart allocation policy of the Organ Procurement and Transplantation Network.
The organ network’s website has a breakdown of what factors contribute to organ allocations.
How are organs delivered to the patients?
There are 56 nonprofits in the country that operate as organ procurement organizations; they are under contract with the federal government. Their job is to retrieve organs and tissues from donors in hospitals, evaluate the organ to see if it could potentially be usable, put the donor’s information into the system, and if there is a match, deliver the organ to the transplant center.
Some organs, such as hearts, lungs and livers, won’t be recovered from the deceased donor unless a match is found, Paschke said. Organs can stay healthy only for a short period of time outside the body. Once removed from a body, they are placed on ice or connected to a machine that pumps blood through them. Hearts and lungs can survive four to six hours, livers, 8 to 12 hours, and kidneys 24 to 36 hours.
One of the nonprofits tasked with recovering organs, Life Alliance Organ Recovery Agency, is a division of the surgery department at the University of Miami medical school. There are three other organ procurement organizations in Florida: LifeQuest Organ Recovery Services, part of the University of Florida’s Shands Teaching Hospital in Gainesville; Our Legacy in Maitland, Central Florida; and LifeLink of Florida, a division of LifeLink Foundation, located in Tampa.
How to find, compare transplant programs?
If you’re looking for a transplant program, or want to see how your transplant center compares to others, there’s a way to do so.
Visit SRTR.org. You can search for programs by organ, ZIP code, state or by the hospital’s name to see how they fare with wait list times, survival, the speed of transplantation and other key measures.
This story was originally published May 15, 2023 5:00 AM.
