behavioral, and social sciences and included patients, patient advocates, and non-transplant physicians. Surgeons and physicians represented each of the ten UNOS geographic regions (one each), and in addition included a President, Immediate Past President, Vice President, Treasurer, and Secretary (total = 15). UNOS later provided for a heart transplant representative to be elected to the Board of Directors, bringing the total number of board members to 32. In addition to enrolling members and creating a governing body, UNOS established an administrative organization with an executive director and assistant executive director and internal departments including: Technical Services and Computer Operations, Professional Education, Communications, Travel, Finance, Membership and Personnel. Later changes in the administrative organization included the addition of a Research and Policy Department with more specific responsibilities for supporting the scientific and policy-making functions of the OPTN.

For administrative purposes, UNOS divided the country into eight geographic regions. Due to size discrepancies and organ sharing concerns, several of the regions were altered to create a ninth, tenth, and eleventh region by the fall of 1989.(Fig. 1) Each region was assigned a UNOS staff administrator to assist in coordinating regional activities and to provide input to the UNOS committees and Board of Directors.

Also in the first year of operation, UNOS created 11 permanent standing committees: Communications, Education, Ethics, Finance, Foreign Relations, Transportation, Membership and Professional Standards, Heart Transplantation, Organ Procurement and Distribution, Histocompatibility and Scientific Advisory. An ad hoc committee on Patient Affairs was later made a permanent standing commit-

Fig. 3.1.

tee. Ad hoc committees presently include Donations, Multiple Listing, Organ Procurement Organizations, and Pediatrics. Currently, committee members are recommended by the regional councilor and are selected to provide broad and experienced input into all committee activities. The president makes the appointment. Committees receive input from regional subcommittees, from the transplant community, and from the public. Each individual member of the OPTN is represented in all deliberations by the transplant organization or institution for whom he or she works.

UNOS established by-laws, membership criteria, and operating policies during its first year of operation. It also established a mechanism for public input into the policy-making process. Additionally, UNOS established a Scientific Registry under a two-year contract with the federal government. The Scientific Registry contains pre- and post-transplant data on all solid organ recipients in the United States as well as data on all donor referrals and actual organ donors.

Membership in the national OPTN was mandated in the Omnibus Budget Reconciliation Act of 1986. This legislation required that transplant centers be members of the OPTN and abide by its rules and policies or stop transplanting organs. If a transplant center elected not to join but to continued transplanting, that center would no longer be eligible to participate in the federal Medicare/Medicaid programs. As a result, membership in UNOS is no longer voluntary, and therefore policies set by UNOS govern all organ transplantation programs in the United States.

One of the provisions of NOTA in 1984 was that the Secretary of HHS would eventually submit a set of OPTN operating rules to the Federal Register; at that time, rules of the OPTN would acquire the force of law. The purpose of any set of rules would be as follows:

• The effectiveness of cadaveric organ procurement and distribution is improved;

• Access to an optimal organ transplant is improved and increased;

• The system for sharing renal and extra-renal organs is improved so as to:

• Facilitate the matching of renal and extra-renal donor organs with potential recipients based on criteria established for each organ;

• Provide a system by which highly immunologically pre-sensitized patients will be afforded the broadest possible opportunity to be matched with an acceptable donor;

• Improve transplant outcome; and

• Decrease organ wastage.

• Quality control is assured by collection, analysis, and publication of data on organ donation, procurement, and transplantation; and

• The professional skills of those involved in organ procurement and transplantation is maintained and improved.

In 1984, UNOS was incorporated as a legal entity, and in 1986, SEOPF gave it its computer matching system. The foundation also gave UNOS the 24-Alert voice-activated computerized matching system for non-renal vascular organs, developed for the North American Transplant Coordinators Organization in Pittsburgh. UNOS received a contract from the federal government effective October 1, 1986,

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