The Division Of Transplantation

Within HRSA, the Division of Transplantation (DOT), in the Office of Special Programs, administers the OPTN and the SRTR. Other DOT activities include providing technical assistance to the 63 OPOs, working with public and private

Organ Transplantation, 2nd edition, edited by Frank P. Stuart, Michael M. Abecassis and Dixon B. Kaufman. ©2003 Landes Bioscience.

organizations to promote donation, serving as a national resource to professional associations, health providers, health insurers, state health departments, and the media about donation and transplantation, and managing the contract with the National Marrow Donor Program to administer the National Bone Marrow Registry for Unrelated Donors.

UNOS History

In the mid-1960s, an important development occurred that had a major effect on organ transplantation. It was determined that by transplanting a cadaveric donor kidney into a recipient that matched genetically, graft survival could be increased. As a result of this development, several transplant centers began to share kidneys as a means of extending kidney survival. Preliminary results of shipping kidneys between centers were successful. With this experience, the Kidney Disease and Control (KDC) Agency of the Public Health Service awarded seven contracts to transplant centers throughout the United States. The purpose of the contracts was to prove the feasibility of procuring kidneys in one place and preserving, matching, and transporting them in a viable condition for transplantation.

The Southeastern Regional Organ Procurement Program (SEROPP) was awarded one of these contracts on June 27, 1969. SEROPP originally had a membership of eight transplant programs in four states and the District of Columbia. It implemented a computerized on-line kidney matching system in December 1969.

In 1975, responding to the increase in activity, the South-Eastern Organ Procurement Foundation (SEOPF) was incorporated with 18 members in a six-state area.

Responding to requests from non-SEOPF transplant centers to utilize the computer system for registering potential recipients and sharing kidneys, the United Network for Organ Sharing (UNOS) was established in January 1977. UNOS was designed to utilize the benefits of a computerized system for matching kidneys nationally. The ultimate objective was to better utilize procured kidneys while improving outcome. UNOS granted access to the computer registry and matching program to any transplant program within the United States. The registry in the late 1970s included not only kidney recipients, but those awaiting other organs as well.

By 1982, UNOS was becoming more of a national sharing network, and because of the complexity of sharing kidneys over a large portion of the country, SEOPF and UNOS created "The Kidney Center." The Kidney Center was staffed 24 hours a day with personnel who could run the computer and locate recipients for kidneys and other organs, arrange kidney transportation, maintain and update registry files for those who requested it, and attempt to locate organs through the UNOS/STAT system for patients who were critically ill. Recipients listed on the computer were assigned "status" codes to reflect urgency of need. When a match was found, the kidney was offered to the recipient center and transplanted there with arrangements made by SEOPF. The transportation of other organs (hearts, livers) remained the responsibility of the donor center since the recipient center sent its own team of surgeons to retrieve the non-renal organ. In 1984, the

Kidney Center became known as the "Organ Center" to reflect its activity with other organs.

In anticipation of changes occurring both in the field of transplantation and in the legislative arena, UNOS was incorporated as a private, non-profit voluntary membership organization in 1984. This action was recommended by two committees, working separately, to determine if UNOS should incorporate to meet the changing demands of the transplant field. UNOS was classified for federal tax purposes as a medical, scientific, and educational organization. The primary mission of the organization was to operate the computerized national recipient registry for patients in need of transplantation and to coordinate the placement of organs procured in the United States through the Organ Center. UNOS was the only organization of its kind offering services to the entire nation. Transplant programs, organ procurement organizations, and histocompatibility laboratories joined UNOS to participate in the efficient and effective distribution of organs for transplantation.

The goals of UNOS, as outlined in the Articles of Incorporation, were to:

• establish a national Organ Procurement and Transplantation Network under the Public Health Services Act;

• improve the effectiveness of the nation's renal and extra-renal organ procurement, distribution, and transplantation systems by increasing the availability of, and access to, donor organs for patients with end-stage organ failure;

• develop, implement, and maintain quality assurance activities; and

• systematically gather and analyze data and regularly publish the results of the national experience in organ procurement and preservation, tissue typing, and clinical organ transplantation.

The UNOS Board of Directors, composed of one representative from each member institution, governed the organization. UNOS and SEOPF remained closely intertwined, sharing office space, computer hardware, and personnel.

In 1986, UNOS sought and was awarded the federal contract to establish and operate the national Organ Procurement and Transplantation Network. With the awarding of the contract, UNOS changed its operation to accommodate the mandates of the law. In making the changes, UNOS sought input from the transplant community and its Board of Directors. UNOS also seriously considered the recommendations of the Task Force on Organ Transplantation. During the first year of operation as the national OPTN, UNOS enrolled new members and elected a new Board of Directors to conform with OPTN contract requirements. While the original Board of Directors consisted of a representative of each member, the new board included representatives of groups of members. As mandated by contract, the board was composed of 15 transplant surgeons and physicians and 16 non-physicians. Non-physicians were representatives of the following UNOS member categories: Independent Organ Procurement Agencies (two representatives), transplant coordinators (two representatives), Tissue Typing Laboratories (two representatives), Voluntary Health Organizations and Public Members (ten representatives). Public members represented the fields of ethics, law, religion,

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