Organ Allocation

The organ allocation system will be only partially explained due to its complexity. At any time, a potential recipient may be placed into an inactive status on the waiting list after initially being added. However, policies are in place regarding the amount of time a patient can continue to accrue while inactive. At a specified time interval, inactive patients remain on the list but discontinue accruing additional waiting time.

The current lung allocation system is based on waiting time, blood group identity and compatibility, and the patient's height. Lung recipients have a single status code.

Hearts are allocated based on two status codes and waiting time. The status codes are dependent on specific criteria regarding the patient's critical condition. Heart/lung recipients are combined systematically within the heart list, however, they are not entered by status codes.

The current liver allocation system has recipients entered by a tiered status code system. The list is based on waiting time and urgency of need. Blood group and recipient size are also included in the allocation algorithm. Intestinal organ allocation is based on two status codes and waiting time. Blood group identity and body size are more important than for livers.

Pancreas and kidney allocation is based on waiting time and HLA matching. Recently the matching system was upgraded by introduction of genetic matching which is more exact than the previously used serologic matching. Kidneys are allocated based on a point system generated from waiting time and HLA matching. A national computer list generated when the donor's antigens are identified, is checked for a "perfect" genetic match. Genetic matching occurs at approved histocompatibility labs and takes approximately six hours from the time the lab receives the donor sample. When "perfect" genetic matches are identified, the OPOs

1o are required to offer kidneys to those recipients nationwide. This is because a perfect match has a better chance for long term success.

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