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How Organ Recipients Are Chosen

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In the United States alone, the organ transplant list comes in at over 120,000 people waiting for a life-saving donation—remarkably, 1 person is added to the list every 10 minutes.

So how are the donated organs and tissues allocated to such a large group of recipients? Keep reading to find out.

General Guidelines for Allocating Organs

If you thought the numbers above were staggering, consider this: just 1 donor (you!) has the potential to save 8 lives by becoming a donor. When the conditions are right, you can donate any or all of the following:

  • Heart.
  • Both lungs.
  • Liver.
  • Pancreas.
  • Both kidneys.
  • Intestines.

When a donor passes away, their hospital notifies the Organ Procurement and Transplantation Network (OPTN). In general, the the OPTN factors in the following when deciding how to allocate your organs are:

  • How well your body size and blood type match that of the recipient(s).
  • The urgency of the recipient’s medical needs.
  • How long the recipient has been waiting for a transplant.
  • The time and distance your organ(s) will have to travel to get to the recipient(s).

Surprisingly, the distance between yourself and the donation recipient plays one of the most crucial roles in determining where your organs will go. Each organ can survive only a certain amount of time outside of the body before it’s no longer viable.

So, even if someone’s at the top of the heart transplant list with a perfect body and blood type match, they may not receive your donated heart if they are too far away. 

Remember, these are general guidelines for determining who receives donated organs and tissues. Below, we’ll cover a few of the criteria specific to each type of commonly donated organ. 

Kidney Recipients

By far, kidneys are the most needed organs. When deciding who will receive kidney donations, the Organ Procurement and Transplantation Network considers the following:

  • Blood type matches.
  • The body sizes of the donor and recipient.
  • Lymphocytotoxic cross-matching, which measures how the recipient’s antibodies react to the donor’s antigens.
  • Tissue typing, which measures the compatibility between the human leukocyte antigens (HLA) on white blood cells of the donor and recipient.

Since kidneys can survive outside of the body for a relatively long time, the distance between organ donor and recipient isn’t a major factor when considering who will receive this organ. 

Liver Recipients

Livers are the next most sought-after organs. The main factors the OPTN uses to choose liver recipients include: 

  • The recipient’s MELD (Model for End-State Liver Disease) or PELD (Pediatric End-State Liver Disease) score.
    • This score measures the level of urgency each patient has for a liver transplant. The higher the MELD/PELD score, the more likely they are to receive a liver.
  • The distance between the donor and the recipient.

It will ultimately be up to the recipient’s surgeon to decide whether or not to accept the donated liver. If the surgeon declines, a local patient with the next highest MELD/PELD score will receive the organ.

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Heart Recipients

Next on the list of most requested organs are hearts. The following factors come into play when determining who will receive a donated heart:

  • The distance between the donor and the recipient.
    • Since hearts cannot survive outside of a body for a long time, recipients who are closer to the organ donor are much more likely to receive the heart.
  • The recipient’s assigned status code, which measures the urgency for a transplant.
  • How well the body size of the donor and recipient match up.
    • It’s important to find the right size heart to ensure it fits comfortably in the recipient’s chest cavity.

Lung Recipients

The Organ Procurement and Transplantation Network uses the following criteria when choosing who will receive lungs, the next most needed organs:

  • The distance between the donor and the recipient.
    • Like heart donations, recipients who are closer to the donor have much higher chances of receiving the lungs, because lungs cannot survive outside of the body for too long.
  • The recipient’s position in the OPTN’s lung allocation system, which determines how urgently a patient needs new lungs and their chances of survival after a transplant.
  • The cohesiveness between the recipient’s and donor’s body size.
    • The donor’s lungs need to be able to fit in the recipient’s rib cage without issue.

If the recipient is in need of a heart AND lungs (and are determined to be compatible), both the donor’s heart and lungs will go to the same recipient. 

Pancreas Recipients

When the OPTN decides who to give a donated pancreas to, they consider:

  • Whether the donor and recipient’s blood types match.
  • How long the recipient has been on the wait list for a pancreas.

Oftentimes, pancreases are transplanted with kidneys, so the criteria for kidney recipients are also taken into consideration when choosing the recipient.

Intestine Recipients

Finally, the main factors used to determine who will receive an intestine transplant include:

  • An identical match of ABO blood group between the donor and recipient.
    • If the blood group is not an exact match, there’s a higher probability the recipient will contract a lethal immune disease.
  • The body size of the organ donor and recipient.
    • Patients who need an intestine transplant often have shrunken abdomens; the donor must be smaller so their intestines will fit into the recipient’s reduced abdominal space.
  • The recipient’s exposure to cytomegalovirus (CMV) and Epstein Barr virus (EBV).
    • Intestine recipients can easily contract CMV and EBV; if they’ve never been exposed, they must receive intestines from a donor who also has never contracted CMV or EBV.

To learn more about the OPTN’s criteria for choosing recipients, head over to their guide to organ allocation systems.

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