Every 12 minutes, another name is added to the list of those in need of organ transplants. More than 90,000 people in the United States waited for organs, yet only about 22,000 will receive them. With such a tremendous gap between those waiting and the number of organs available, it becomes painfully clear that the question to be answered is: how is it decided who gets an organ? In an attempt to create a fair and equitable system of organ distribution, the United Network of Organ Sharing (UNOS) was created.

All patients accepted into a transplant program are registered with UNOS, which maintains the national list of patients waiting for organ transplants and coordinates placement of organs that become available. It maintains a centralized computer network linking all the organ procurement organizations, such as Carolina Donor Services, with transplant centers. This computer network is accessible 24 hours a day, seven days a week. When a donor organ becomes available, the organ procurement organization accesses the UNOS network, which generates a list of patients ranked according to the UNOS policies on organ allocation.

Ranking
When a patient's name is added to the list, his or her medical profile is entered and stored in the UNOS network. The patient isn't placed on a ranked list at this time, it's added to a pool of patient names. When a donor organ becomes available, each patient in the pool is matched against the donor characteristics. The computer then generates a list of patients ranked in order based upon medical and scientific criteria. All patients in the pool are compared to that particular donor; they are ranked in the order of who makes the best match. The match is made according to body size, blood type, time waiting, immunological status, medical urgency and logistics.

Decision to Transplant
After receiving the UNOS printout, the procurement coordinator contacts the transplant team physician responsible for the care of the patient who appears first on the list. The transplant physician decides whether the transplant recipient and the donor organ are suitable for one another. He/she must consider whether the patient is available, healthy enough to undergo major surgery, and is willing to be transplanted immediately. Also, a laboratory test to measure compatibility between the donor and recipient may be necessary. Once these steps have been taken, surgery is scheduled and the transplant occurs.

The Link
The organ sharing system is a diverse program that allows patients to be evaluated for transplant regardless of age, race, sex, or financial status. UNOS is constantly monitoring statewide systems of organ allocation to ensure that all recovery agencies, such as Carolina Donor Services, are distributing available organs fairly. With the increasing need for organs, it remains clear that this system is currently the best way to determine who is the most suitable for available donor organs.