UNOS: United Network for Organ Sharing
History of the National Organ Procurement and Transplantation Network
In the early 1980s, the advent of the immunosuppressant drug cyclosporine made the transplantation of organs other than kidneys feasible. This development led individuals to appeal to the public through the media and their legislators for assistance in finding suitable donor organs. The demand for these organs greatly exceeded the supply.
There was no centralized network to increase the utilization of scarce donated organs nor were there criteria governing how an individual obtained access to transplantation. To further complicate matters there was a growing concern that wealthy citizens of foreign countries were coming to the United States to take advantage of transplantation technology to the detriment of terminally ill U. S. citizens also in need of the same technology.
These issues resulted in public demand for the implementation of a national system. Thus, the National Transplant Act of 1984 was passed by Congress. The act called for the creation of a national task force to study issues regarding transplantation and establishment of a new National Organ Procurement and Transplantation Network (OPTN). The OPTN includes all organ procurement organizations, transplant centers and tissue typing laboratories as well as patients, patient families, donor families, hospitals, voluntary health organizations and thousands of other dedicated individuals including physicians, other health care professionals, ethicists, clergy, social scientists, attorneys, health care management and government officials.
The principal purpose of the OPTN is to ensure access to organs by critically ill patients and improve organ procurement and efficiency. Another key element of the OPTN is the development and administration of policy by the transplant community. The OPTN develops membership criteria standards based on training and experience of medical personnel. For example, an approved kidney transplant program should have a surgeon who has a year of training and a year of experience in kidney transplantation. In addition, centers approved for liver or pancreas transplants should have a surgeon with training and experience in the transplantation of the organ being transplanted.
The National Transplant Act was passed in October 1984. This act created a task force on organ transplantation that met over a period of 18 months and issued its report in April 1986. The Department of Health and Human Services (DHHS) awarded a one-year contract for the development and implementation of the national network to the United Network for Organ Sharing (UNOS) on September 30, 1986. UNOS immediately implemented parts of the network but did not complete full implementation until the end of the first year, as called for in the contract. The entire system went into effect October 1, 1987. The network has been fully operational for nearly 10 years.
All clinical transplant centers, organ procurement organizations and tissue typing laboratories in the United States belong to and participate in UNOS. UNOS members have developed membership criteria based on the education, training and experience of medical personnel and monitor compliance with those standards to ensure high quality and consistent patient care. A national waiting list of all patients in the country waiting for solid organ transplantation is maintained on the UNOS computer system. UNOS operates a 24-hour-a-day organ placement center and computer system to ensure efficient and optimal matching of donors and recipients.
Policies ensuring access to and allocation of organs are in place and are monitored through the use of a national computer system. To facilitate the development of policy and improve scientific methods, UNOS maintains a Scientific Registry, which contains scientific and demographic data on all organ donors and tracks all organ recipients throughout their lives.
Members of the UNOS Board of Directors and its 15 permanent and 4 ad hoc committees include members of the public as well as patients. Included are experts from the fields of medicine, law, ethics, theology, social and behavioral sciences and health care financing. UNOS distributes the scientific and medical rationale for its policies for public comment and, where appropriate, holds public hearings. UNOS operates as the OPTN under contract with the U. S. Department of Health and Human Services and submits to department oversight, providing extensive information to the department for its review regarding OPTN policies.
United Network for Organ Sharing (UNOS)
Every patient waiting for an organ transplant in the United States is registered in the UNOS computerized data network. All have equal access to donated organs. The 68 organ recovery organizations across the country are members of UNOS.
When an organ procurement organization coordinator contacts UNOS, the UNOS technician inputs the organ donor's medical history, physical measurements, and blood type, and prints a computerized list of likely transplant recipients. The list is printed in order of matching priority, which includes medical criteria, length of time waiting, blood type, body weight, size of recipient diseased organ, and severity of illness. Kidney and pancreas recipients are also matched by tissue (genetic) typing.
If the first potential recipient does not match medically with the available organ, the OPO coordinator maintains the computer search in an assigned region or elsewhere in the nation for a potential recipient who most nearly matches the donor. Likewise, organ recovery organizations throughout the United States will notify each other when an organ becomes available for waiting recipients in their respective areas.
Matching donor organs with recipients is critical. Transplant waiting times may vary from a few months to several years because of matching difficulties.